Exposure to conditions of high concentrations of indoor air pollutants and prevalence of ARIs in children under 5 years of age, in Ouagadougou/Burkina Faso

The objective was to highlight effects of exposure to high concentrations of PM2.5 (emitted during cooking) on the prevalence of acute respiratory infections (ARI) in children under 5 years of age. Results showed that the use of biomass in indoor kitchens in residential buildings in Uganda was linked to the occurrence of ARI in children. Living in a house with several bedrooms was a protective factor. Fine particulate matter (PM2.5) is an air pollutant which can affect people's health when levels are high

Postmortem investigations and identification of multiple causes of child deaths: An analysis of findings from the Child Health and Mortality Prevention Surveillance (CHAMPS) network

BACKGROUND: The current burden of >5 million deaths yearly is the focus of the Sustainable Development Goal (SDG) to end preventable deaths of newborns and children under 5 years old by 2030. To accelerate progression toward this goal, data are needed that accurately quantify the leading causes of death, so that interventions can target the common causes. By adding postmortem pathology and microbiology studies to other available data, the Child Health and Mortality Prevention Surveillance (CHAMPS) network provides comprehensive evaluations of conditions leading to death, in contrast to standard methods that rely on data from medical records and verbal autopsy and report only a single underlying condition. We analyzed CHAMPS data to characterize the value of considering multiple causes of death. METHODS AND FINDINGS: We examined deaths identified from December 2016 through November 2020 from 7 CHAMPS sites (in Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa), including 741 neonatal, 278 infant, and 241 child <5 years deaths for which results from Determination of Cause of Death (DeCoDe) panels were complete. DeCoDe panelists included all conditions in the causal chain according to the ICD-10 guidelines and assessed if prevention or effective management of the condition would have prevented the death. We analyzed the distribution of all conditions listed as causal, including underlying, antecedent, and immediate causes of death. Among 1,232 deaths with an underlying condition determined, we found a range of 0 to 6 (mean 1.5, IQR 0 to 2) additional conditions in the causal chain leading to death. While pathology provides very helpful clues, we cannot always be certain that conditions identified led to death or occurred in an agonal stage of death. For neonates, preterm birth complications (most commonly respiratory distress syndrome) were the most common underlying condition (n = 282, 38%); among those with preterm birth complications, 256 (91%) had additional conditions in causal chains, including 184 (65%) with a different preterm birth complication, 128 (45%) with neonatal sepsis, 69 (24%) with lower respiratory infection (LRI), 60 (21%) with meningitis, and 25 (9%) with perinatal asphyxia/hypoxia. Of the 278 infant deaths, 212 (79%) had ≥1 additional cause of death (CoD) beyond the underlying cause. The 2 most common underlying conditions in infants were malnutrition and congenital birth defects; LRI and sepsis were the most common additional conditions in causal chains, each accounting for approximately half of deaths with either underlying condition. Of the 241 child deaths, 178 (75%) had ≥1 additional condition. Among 46 child deaths with malnutrition as the underlying condition, all had ≥1 other condition in the causal chain, most commonly sepsis, followed by LRI, malaria, and diarrheal disease. Including all positions in the causal chain for neonatal deaths resulted in 19-fold and 11-fold increases in attributable roles for meningitis and LRI, respectively. For infant deaths, the proportion caused by meningitis and sepsis increased by 16-fold and 11-fold, respectively; for child deaths, sepsis and LRI are increased 12-fold and 10-fold, respectively. While comprehensive CoD determinations were done for a substantial number of deaths, there is potential for bias regarding which deaths in surveillance areas underwent minimally invasive tissue sampling (MITS), potentially reducing representativeness of findings. CONCLUSIONS: Including conditions that appear anywhere in the causal chain, rather than considering underlying condition alone, markedly changed the proportion of deaths attributed to various diagnoses, especially LRI, sepsis, and meningitis. While CHAMPS methods cannot determine when 2 conditions cause death independently or may be synergistic, our findings suggest that considering the chain of events leading to death can better guide research and prevention priorities aimed at reducing child deaths

Deaths Attributed to Respiratory Syncytial Virus in Young Children in High-Mortality Rate Settings: Report from Child Health and Mortality Prevention Surveillance (CHAMPS).

BACKGROUND: Lower respiratory tract infections are a leading cause of death in young children, but few studies have collected the specimens needed to define the role of specific causes. The Child Health and Mortality Prevention Surveillance (CHAMPS) platform aims to investigate causes of death in children aged <5 years in high-mortality rate settings, using postmortem minimally invasive tissue sampling and other advanced diagnostic techniques. We examined findings for deaths identified in CHAMPS sites in 7 countries in sub-Saharan Africa and south Asia to evaluate the role of respiratory syncytial virus (RSV). METHODS: We included deaths that occurred between December 2016 and December 2019. Panels determined causes of deaths by reviewing all available data including pathological results from minimally invasive tissue sampling, polymerase chain reaction screening for multiple infectious pathogens in lung tissue, nasopharyngeal swab, blood, and cerebrospinal fluid samples, clinical information from medical records, and verbal autopsies. RESULTS: We evaluated 1213 deaths, including 695 in neonates (aged <28 days), 283 in infants (28 days to <12 months), and 235 in children (12-59 months). RSV was detected in postmortem specimens in 67 of 1213 deaths (5.5%); in 24 deaths (2.0% of total), RSV was determined to be a cause of death, and it contributed to 5 other deaths. Younger infants (28 days to <6 months of age) accounted for half of all deaths attributed to RSV; 6.5% of all deaths in younger infants were attributed to RSV. RSV was the underlying and only cause in 4 deaths; the remainder (n = 20) had a median of 2 (range, 1-5) other conditions in the causal chain. Birth defects (n = 8) and infections with other pathogens (n = 17) were common comorbid conditions. CONCLUSIONS: RSV is an important cause of child deaths, particularly in young infants. These findings add to the substantial body of literature calling for better treatment and prevention options for RSV in high-mortality rate settings

Neural tube defects as a cause of death among stillbirths, infants, and children younger than 5 years in sub-Saharan Africa and southeast Asia: an analysis of the CHAMPS network

BACKGROUND: Neural tube defects are common birth defects resulting in severe morbidity and mortality; they can largely be prevented with periconceptional maternal intake of folic acid. Understanding the occurrence of neural tube defects and their contribution to mortality in settings where their burden is highest could inform prevention and health-care policy. We aimed to estimate the mortality attributed to neural tube defects in seven countries in sub-Saharan Africa and southeast Asia. METHODS: This analysis used data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network and health and demographic surveillance systems from South Africa, Mozambique, Bangladesh, Kenya, Mali, Ethiopia, and Sierra Leone. All stillbirths and infants and children younger than 5 years who died, who were enrolled in CHAMPS, whose families consented to post-mortem minimally invasive tissue sampling (MITS) between Jan 1, 2017, and Dec 31, 2021, and who were assigned a cause of death by a determination of cause of death panel as of May 24, 2022, were included in this analysis, regardless the cause of death. MITS and advanced diagnostic methods were used to describe the frequency and characteristics of neural tube defects among eligible deaths, identify risk factors, and estimate the mortality fraction and mortality rate (per 10 000 births) by CHAMPS site. FINDINGS: Causes of death were determined for 3232 stillbirths, infants, and children younger than 5 years, of whom 69 (2%) died with a neural tube defect. Most deaths with a neural tube defect were stillbirths (51 [74%]); 46 (67%) were neural tube defects incompatible with life (ie, anencephaly, craniorachischisis, or iniencephaly) and 22 (32%) were spina bifida. Deaths with a neural tube defect were more common in Ethiopia (adjusted odds ratio 8·09 [95% CI 2·84-23·02]), among female individuals (4·40 [2·44-7·93]), and among those whose mothers had no antenatal care (2·48 [1·12-5·51]). Ethiopia had the highest adjusted mortality fraction of deaths with neural tube defects (7·5% [6·7-8·4]) and the highest adjusted mortality rate attributed to neural tube defects (104·0 per 10 000 births [92·9-116·4]), 4-23 times greater than in any other site. INTERPRETATION: CHAMPS identified neural tube defects, a largely preventable condition, as a common cause of death among stillbirths and neonatal deaths, especially in Ethiopia. Implementing interventions such as mandatory folic acid fortification could reduce mortality due to neural tube defects. FUNDING: Bill & Melinda Gates Foundation

Burden of child mortality from malaria in high endemic areas: results from the CHAMPS Network using minimally invasive tissue sampling

Background Malaria is a leading cause of childhood mortality worldwide. However, accurate estimates of malaria prevalence and causality among patients who die at the country level are lacking due to the limited specificity of diagnostic tools used to attribute etiologies. Accurate estimates are crucial for prioritizing interventions and resources aimed at reducing malaria-related mortality. Methods Seven Child Health and Mortality Prevention Surveillance (CHAMPS) Network sites collected comprehensive data on stillbirths and children <5 years, using minimally invasive tissue sampling (MITS). A DeCoDe (Determination of Cause of Death) panel employed standardized protocols for assigning underlying, intermediate, and immediate causes of death, integrating sociodemographic, clinical, laboratory (including extensive microbiology, histopathology, and malaria testing), and verbal autopsy data. Analyses were conducted to ascertain the strength of evidence for cause of death (CoD), describe factors associated with malaria-related deaths, estimate malaria-specific mortality, and assess the proportion of preventable deaths. Findings Between December 3, 2016, and December 31, 2022, 2673 deaths underwent MITS and had a CoD attributed from four CHAMPS sites with at least 1 malaria-attributed death. No malaria-attributable deaths were documented among 891 stillbirths or 924 neonatal deaths, therefore this analysis concentrates on the remaining 858 deaths among children aged 1-59 months. Malaria was in the causal chain for 42.9% (126/294) of deaths from Sierra Leone, 31.4% (96/306) in Kenya, 18.2% (36/198) in Mozambique, 6.7% (4/60) in Mali, and 0.3% (1/292) in South Africa. Compared to non-malaria related deaths, malaria-related deaths skewed towards older infants and children (p<0.001), with 71.0% among ages 12-59 months. Malaria was the sole infecting pathogen in 184 (70.2%) of malaria-attributed deaths, whereas bacterial and viral co-infections were identified in the causal pathway in 24·0% and 12.2% of cases, respectively. Malnutrition was found at a similar level in the causal pathway of both malaria (26.7%) and non-malaria (30.7%, p=0.256) deaths. Less than two-thirds (164/262; 62.6%) of malaria deaths had received antimalarials prior to death. Nearly all (98·9%) malaria-related deaths were deemed preventable. Interpretation Malaria remains a significant cause of childhood mortality in the CHAMPS malaria-endemic sites. The high bacterial co-infection prevalence among malaria deaths underscores the potential benefits of antibiotics for severe malaria patients. Compared to non-malaria deaths, many of malaria-attributed deaths are preventable through accessible malaria control measures. Funding This work was supported by the Bill & Melinda Gates Foundation [OPP1126780]

Prioritizing Health Care Strategies to Reduce Childhood Mortality

IMPORTANCE: Although child mortality trends have decreased worldwide, deaths among children younger than 5 years of age remain high and disproportionately circumscribed to sub-Saharan Africa and Southern Asia. Tailored and innovative approaches are needed to increase access, coverage, and quality of child health care services to reduce mortality, but an understanding of health system deficiencies that may have the greatest impact on mortality among children younger than 5 years is lacking. OBJECTIVE: To investigate which health care and public health improvements could have prevented the most stillbirths and deaths in children younger than 5 years using data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used longitudinal, population-based, and mortality surveillance data collected by CHAMPS to understand preventable causes of death. Overall, 3390 eligible deaths across all 7 CHAMPS sites (Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) between December 9, 2016, and December 31, 2021 (1190 stillbirths, 1340 neonatal deaths, 860 infant and child deaths), were included. Deaths were investigated using minimally invasive tissue sampling (MITS), a postmortem approach using biopsy needles for sampling key organs and fluids. MAIN OUTCOMES AND MEASURES: For each death, an expert multidisciplinary panel reviewed case data to determine the plausible pathway and causes of death. If the death was deemed preventable, the panel identified which of 10 predetermined health system gaps could have prevented the death. The health system improvements that could have prevented the most deaths were evaluated for each age group: stillbirths, neonatal deaths (aged <28 days), and infant and child deaths (aged 1 month to <5 years). RESULTS: Of 3390 deaths, 1505 (44.4%) were female and 1880 (55.5%) were male; sex was not recorded for 5 deaths. Of all deaths, 3045 (89.8%) occurred in a healthcare facility and 344 (11.9%) in the community. Overall, 2607 (76.9%) were deemed potentially preventable: 883 of 1190 stillbirths (74.2%), 1010 of 1340 neonatal deaths (75.4%), and 714 of 860 infant and child deaths (83.0%). Recommended measures to prevent deaths were improvements in antenatal and obstetric care (recommended for 588 of 1190 stillbirths [49.4%], 496 of 1340 neonatal deaths [37.0%]), clinical management and quality of care (stillbirths, 280 [23.5%]; neonates, 498 [37.2%]; infants and children, 393 of 860 [45.7%]), health-seeking behavior (infants and children, 237 [27.6%]), and health education (infants and children, 262 [30.5%]). CONCLUSIONS AND RELEVANCE: In this cross-sectional study, interventions prioritizing antenatal, intrapartum, and postnatal care could have prevented the most deaths among children younger than 5 years because 75% of deaths among children younger than 5 were stillbirths and neonatal deaths. Measures to reduce mortality in this population should prioritize improving existing systems, such as better access to antenatal care, implementation of standardized clinical protocols, and public education campaigns

Choix énergétiques dans les ménages et pollution de l’air domestique à Ouagadougou, Burkina Faso :caractérisation de l’exposition et de l’effet sur la santé respiratoire des femmes

Introduction :Dans la plus grande partie du monde en développement, la pollution de l’air domestique liée à l’utilisation de combustibles solides constitue un grave risque sanitaire et contribue fortement à la charge de mortalité et de morbidité.En effet, dans ces pays, près de 3 milliards de personnes continuent d’utiliser des combustibles traditionnels tirés de la biomasse (bois, résidus agricoles, excréments d’animaux, charbon de bois), pour cuire les aliments et / ou se chauffer, causant ainsi le décès prématuré d’environ 3,8 millions de personnes chaque année.Au Burkina Faso, comme dans la plupart des pays d’Afrique de l’Ouest, l’utilisation de combustibles solides, notamment à base de biomasse, est encore très répandue. En 2014, 89, 3% des ménages burkinabé continuaient d’avoir recours aux combustibles solides à base de biomasse pour la cuisine. A Ouagadougou, près de 56 % des ménages continuaient de recourir au bois de chauffe ou au charbon de bois pour la cuisine. Quels sont les facteurs déterminant les choix énergétiques et l’impact de ces choix en termes d’exposition et de risques sur la santé respiratoire des femmes en charge des activités culinaires dans les ménages ?L’objectif général de ce projet de thèse était d’apporter une réponse à cette question. Plus spécifiquement, il s’agissait de :- Estimer les prévalences des manifestations respiratoires tels que certains symptômes respiratoires aiguës et chroniques, la bronchopneumopathie chronique obstructive (BPCO) et l’asthme, chez les femmes chargées principalement de la cuisine dans les ménages ;- Déterminer la relation entre la pollution liée à l’utilisation de combustibles à base de biomasse et les manifestations respiratoires chez les femmes en charge de la cuisine dans les ménages ;- Caractériser le niveau de pollution de l’air dans les ménages en fonction des choix énergétiques pour la cuisine familiale ;- Identifier les facteurs qui influencent les choix énergétiques pour la cuisine familiale dans la ville de Ouagadougou.Matériels et méthodes :Pour l’atteinte de nos objectifs de recherche, les travaux menés au cours de cette thèse étaient de quatre ordres en fonction de leurs approches méthodologiques respectives.- Une revue systématique visant à mettre en évidence l’impact de l’exposition à la fumée de combustibles de type biomasse sur la survenue de BPCO chez la femme.- Une étude transversale à visée descriptive :Il s’agit d’une étape qui a permis de caractériser les ménages et les femmes impliquées dans l’étude et de déterminer les préférences énergétiques pour la cuisine. - Une étude transversale à visée analytique afin de comparer l’état de santé respiratoire, assimilé à la présence d’un certain nombre de symptômes respiratoires, la prévalence de la BPCO et celle de l’asthme, selon les choix énergétiques.- Une étude observationnelle de type cas-témoins ayant pour but de comparer le niveau d’exposition aux polluants émis par la combustion de la biomasse dans la cuisine entre le groupe des femmes malades de BPCO identifiées lors de la phase précédente et celui des femmes témoins indemnes de la BPCO.- Une étude transversale complémentaire a été conduite afin d’évaluer l’exposition à pollution de l’air domestique en fonction des conditions de préparation des repas dans les ménages. Des mesures environnementales ont été réalisées.Les enquêtes ont été menées dans trois quartiers (secteurs) de la commune de Ouagadougou :Kilwin, Tampouy et Tanghin, entre mars 2017 et septembre 2018.Le traitement statistique des données de ces études a donné lieu à plusieurs analyses descriptives et explicatives dans lesquelles nous avons présenté, en plus des statistiques usuelles, les odds ratio et leur intervalle de confiance à 95% et les tests d’association calculés grâce au logiciel Stata/SE version 12 et 13. Une P valeur ≤ 0,05 sera considérée comme significative.Pour l’estimation de la force des associations entre les variables d’exposition (le principal combustible utilisé pour la cuisine ou les concentrations moyennes de polluants) et les variables d’intérêt, l’analyse était d’abord univariée, puis multivariée afin d’estimer des risques propres débarrassés des facteurs confondants et des facteurs modificateurs d’effet.Résultats :Les résultats obtenus ont fait l’objet de publications. Pour l’essentiel, les différentes analyses en viennent aux constatations suivantes :- L’exposition domestique à la fumée de la biomasse est un facteur de risque de BPCO chez les femmes dans le monde. Il y a peu d’études africaines sur le sujet.- L’état de santé respiratoire est assez préoccupant chez les femmes chargées des activités de cuisine dans les ménages. La prévalence de la BPCO était de 2.26% dont une prévalence de 1.06% de BPCO diagnostiquée à la spirométrie et 1.17% de bronchite chronique. Toutes les femmes dépistées BPCO à la spirométrie avaient déclaré l’utilisation de la biomasse énergie comme principale combustible pour les préparations culinaires. L’asthme a été diagnostiquée chez 18.18% des femmes.- Il existe de grandes disparités de santé respiratoire entre les femmes utilisant principalement le bois ou le charbon de bois pour la cuisine et celles utilisant le gaz. L’utilisation de la biomasse comme combustible de cuisine a une influence sur la survenue de plusieurs symptômes respiratoires aigus et chroniques, de la BPCO et de l’asthme. - Les concentrations de PM2.5, contenant des poussières particulaires ayant une taille leur permettant d’atteindre les régions bronchiolaires et alvéolaires, émises dans les cuisines sur 24h étaient i) au-delà des valeurs recommandées par l’OMS pour la qualité de l’air intérieur, ii) plus élevées dans les cuisines où l’on brûle du bois et ou du charbon de bois en comparaison aux cuisines où l’on utilisait des foyers à gaz, iii) plus élevées dans les foyers traditionnels que les foyers améliorés, iiii) plus élevées dans foyers améliorés à charbon que les foyers améliorés à bois.- La différence dans la concentration moyenne de PM2.5 dans les cuisines entre les femmes avec une BPCO et sans une BPCO était non significative.- Environ 60% des ménages avait recours principalement à des combustibles à base de biomasse pour la préparation des repas. - Près de 85% des ménages combinent au moins 2 types de combustibles afin de satisfaire leur besoin énergétique dans le cadre de la cuisine. - Le statut socio-économique, la taille du ménage, le niveau d’instruction et l’âge de la femme en charge de la cuisine, le type de combustible utilisé chez ses parents, sont des facteurs qui influencent les choix énergétiques. Discussion :L’utilisation de combustibles polluants tels que les combustibles traditionnels de type biomasse, au centre de ces symptômes et maladies respiratoires chroniques, comme l’ont montré nos différents résultats, est malheureusement très répandue dans plusieurs pays d’Afrique sub-saharienne tels que le Burkina Faso. L’adoption de la biomasse énergie n’est pas seulement l’apanage des populations des zones rurales. Les préférences pour ce type d’énergie sont encore très populaires dans les zones urbaines. L’identification des déterminants des choix énergétiques, mettant l’accent sur ceux axés sur la personne chargée de la préparation des repas dans le ménage revêt une grande importance. Dans les pays en développement, la cuisine est une activité féminine, de sorte que le choix de l’énergie de cuisson domestique n’est pas seulement attribué au chef de ménage, mais aussi à la femme en charge des activités culinaires dans le ménage.Nos résultats nous permettent d’affirmer que, malgré les subventions gouvernementales pour maintenir le prix du gaz de pétrole liquéfié (GPL) relativement abordable, les combustibles de cuisson à base de biomasse restent en tête de liste des choix des ménages de Ouagadougou. Le bois a été la première source d’énergie contrôlée par l’homme lorsque l’utilisation du feu a été découverte. L’utilisation du bois dans la cuisine pour la préparation des repas, est une question d’habitude. Dans ces cas, l’amélioration des performances techniques des foyers traditionnels, en ajoutant une cheminée par exemple, pourrait être plus accepté et constituer une alternative plus rentable pour réduire la consommation de combustibles, réduire les émissions de fumée et l’exposition aux polluants, tout en respectant les habitudes et les besoins culturels des individus.De nombreuses études interventionnelles ont suggéré que l’amélioration de la ventilation des foyers et/ou de la cuisine peut réduire les concentrations de polluants dans la cuisine pendant la cuisson, l’exposition personnelle et les effets sur la santé de l’exposition à la fumée de la combustion de la biomasse, aussi bien chez les femmes que chez les enfants de moins de 5 ans.Cependant, même si les niveaux de pollution sont réduits lorsque les foyers traditionnels sont améliorés, ils demeurent considérablement plus élevés que les valeurs guides recommandées par l’Organisation mondiale de la santé pour la qualité de l’air intérieur. Ces foyers semblent plus économes en énergie, mais ont encore des niveaux d’émissions de polluants élevées.Le défi consiste à concevoir des foyers à biomasse à la fois écoénergétiques et qui réduisent les émissions à des niveaux suffisamment bas pour préserver la santé. Des stratégies pour assurer l’accès des ménages à des combustibles à la fois peu polluants, fiables et abordables financièrement, et des stratégies pour soutenir le passage au GPL ou au solaire, sont nécessaires. Conclusion :L’exposition à la fumée de la biomasse énergie cause des dommages respiratoires aux femmes en charge de la cuisine dans les ménages. Il est plus qu’urgent d’accélérer la transition énergétique. Des stratégies pour assurer l’accès des ménages à des combustibles à la fois peu polluants, fiables et abordables financièrement, et des stratégies pour soutenir le passage au GPL ou au solaire, sont nécessaires. Outre les subventions gouvernementales qui permettent à une partie de la population d’utiliser le GPL comme principal combustible de cuisson, d’autres initiatives doivent être mises en œuvre, en particulier pour les plus pauvres pour lesquels les prix du GPL malgré la subvention restent hors de portée et pour ceux qui, culturellement ou par habitude, restent réticents aux combustibles modernes, afin de leur permettre à tous un accès à une énergie propre et saine. Dans les communautés pauvres, des initiatives qui permettent des paiements par versements en plusieurs fois, pour l’acquisition d’équipements de cuisine peu polluants, doivent être mises en œuvre et encouragées, afin de soutenir leur désir de changement. Améliorer les connaissances et les comportements des femmes grâce à des campagnes de sensibilisation participatives sur les effets nocifs de l’utilisation de combustibles à biomasse peut être bénéfique.Doctorat en Santé Publiqueinfo:eu-repo/semantics/nonPublishe

Knowledge and perceptions of health and environmental risks related to artisanal gold mining by the artisanal miners in Burkina Faso: A cross-sectional survey

Introduction: Artisanal gold mining is an activity ensuring the survival of about 700,000 families in Burkina Faso with a considerable contribution to the national economy. Techniques and chemicals used in the operation, have adverse impacts on health and the environment. Our study aims to evaluate the perceptions and knowledge of these different impacts among artisanal gold miners. Methods: A cross-sectional survey was conducted in artisanal gold mines Bouda and Nagsene in the region of the North of Burkina Faso. Two hundred miners over 18 years of age were interviewed. Results: All the participants have recognized that gold mining has health impacts and 88.5% felt these impacts as important with a significantly higher proportion among those with more than 3 years' seniority (p = 0.001). The environmental impacts were perceived as important by 64.5% of miners, with a significant difference according to the position (p = 0.004). Sixty percent (60%) of respondents could identify at least 3 of the 5 health impacts of gold mining listed and 49.5% acknowledged at least 3 impacts on the environment. The diggers had significantly more knowledge about the symptoms (p < 0.001). Conclusion: Study highlights the lack of knowledge of the Stampeders on the health and environmental impacts of artisanal gold mining. Findings might be used to develop more effective awareness campaigns in the future. Communication with diggers must focus on the risk perception because it appears that raising risk perceptions from low to high would have a major effect on behavior.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Chronic obstructive pulmonary disease associated with biomass fuel use in women: a systematic review and meta-analysis

Introduction Chronic obstructive pulmonary disease (COPD) is a major and growing cause of morbidity and mortality worldwide. The global prevalence of COPD is growing faster in women than in men. Women are often exposed to indoor pollutants produced by biomass fuels burning during household activities. Methods We conducted a meta-analysis to establish the association between COPD and exposure to biomass smoke in women. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched MEDLINE and Scopus databases in 31December 2016, with the terms: "wood", "charcoal", "biomass", "solid fuels", "organic fuel", "biofuel", "female", "women", "COPD", "chronic bronchitis", "emphysema", "chronic obstructive pulmonary disease". Studies were eligible if they were case-control or cross-sectional studies involving exposure to indoor biomass smoke, conducted at any time and in any geographic location. Fixed-effects or random-effects meta-analysis was used to generate pooled OR. Results 24 studies were included: 5 case-control studies and 19 cross-sectional studies. Biomass-exposed individuals were 1.38 times more likely to be diagnosed with COPD than non-exposed (OR 1.38, 95% CI 1.28 to 1.57). Spirometry-diagnosed COPD studies failed to show a significant association (OR 1.20, 95% CI 0.99 to 1.40). Nevertheless, the summary estimate of OR for chronic bronchitis (CB) was significant (OR 2.11, 95% CI 1.70 to 2.52). The pooled OR for cross-sectional studies and case-control studies were respectively 1.82 (95% CI 1.54 to 2.10) and 1.05 (95% CI 0.81 to 1.30). Significant association was found between COPD and biomass smoke exposure for women living as well in rural as in urban areas. Conclusions This study showed that biomass smoke exposure is associated with COPD in rural and urban women. In many developing countries, modern fuels are more and more used alongside traditional ones, mainly in urban area. Data are needed to further explore the benefit of the use of mixed fuels for cooking on respiratory health, particularly on COPD reduction.SCOPUS: re.jinfo:eu-repo/semantics/publishe