Air pollution and hospitalization due to angina pectoris in Tehran, Iran: A time-series study

Background: Health effects of air pollution have been studied in many different parts of the world. Although a fairly large number of studies have explored the cardiovascular impacts of air pollution, because of its unique location we studied the association between air pollutants and hospital admissions due to angina pectoris in Tehran for the first time. Methods: This is a retrospective time-series study. The variables of the study include the levels of five air pollutants - nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3), sulfur dioxide (SO2), and particulate matter <10 μm in aerodynamic diameter (PM10) - as independent variables; daily hospitalizations due to angina pectoris in 25 academic hospitals in Tehran as the dependent variable; and mean daily temperature and humidity, seasonality, time trend, and day of the week as potential confounders. All variables were measured during a 5-year period from 21 March 1996 to 20 March 2001. The data of mean daily levels of NO2, CO, O3, SO2, and PM10 were collected from one of the stations of Tehran's Air Quality Control Corp. Data were analyzed using Poisson regression models. Relative risks of angina pectoris admissions were calculated for an increase in 1 mg/m3 for CO and 10 μg/m 3 for the other pollutants. Results: Daily admissions due to angina pectoris were significantly related to the CO level, after controlling for confounder effects. Each unit increase in the CO level caused a 1.00934 increase in the number of admissions (95 CI, 1.00359-1.01512). This association was verified with a lag of 1 day. There was no significant association between the other air pollutants and the number of daily admission due to angina pectoris. Conclusions: We found that with increasing levels of the pollutant CO, the number of admissions due to cardiac angina rose. Ischemic heart disease is the leading cause of death in Iran. Air pollution control will reduce the number of this preventable disease and resulting deaths. © 2004 Elsevier Inc. All rights reserved

Addressing Inequity to Achieve the Maternal and Child Health Millennium Development Goals: Looking Beyond Averages.

Inequity in access to and use of child and maternal health interventions is impeding progress towards the maternal and child health Millennium Development Goals. This study explores the potential health gains and equity impact if a set of priority interventions for mothers and under fives were scaled up to reach national universal coverage targets for MDGs in Tanzania. We used the Lives Saved Tool (LiST) to estimate potential reductions in maternal and child mortality and the number of lives saved across wealth quintiles and between rural and urban settings. High impact maternal and child health interventions were modelled for a five-year scale up, by linking intervention coverage, effectiveness and cause of mortality using data from Tanzania. Concentration curves were drawn and the concentration index estimated to measure the equity impact of the scale up. In the poorest population quintiles in Tanzania, the lives of more than twice as many mothers and under-fives were likely to be saved, compared to the richest quintile. Scaling up coverage to equal levels across quintiles would reduce inequality in maternal and child mortality from a pro rich concentration index of -0.11 (maternal) and -0.12 (children) to a more equitable concentration index of -0,03 and -0.03 respectively. In rural areas, there would likely be an eight times greater reduction in maternal deaths than in urban areas and a five times greater reduction in child deaths than in urban areas. Scaling up priority maternal and child health interventions to equal levels would potentially save far more lives in the poorest populations, and would accelerate equitable progress towards maternal and child health MDGs

Social Determinants of Smoking in Low- and Middle-Income Countries: Results from the World Health Survey

INTRODUCTION: Tobacco smoking is a leading cause of premature death and disability, and over 80% of the world's smokers live in low- or middle-income countries. The objective of this study is to assess demographic and socioeconomic determinants of current smoking in low- and middle-income countries. METHODS: We used data, from the World Health Survey in 48 low-income and middle-income countries, to explore the impact of demographic and socioeconomic factors on the current smoking status of respondents. The data from these surveys provided information on 213,807 respondents aged 18 years or above that were divided into 4 pooled datasets according to their sex and country income group. The overall proportion of current smokers, as well as the proportion by each relevant demographic and socioeconomic determinant, was calculated within each of the pooled datasets, and multivariable logistic regression was used to assess the association between current smoking and these determinants. RESULTS: The odds of smoking were not equal in all demographic or socioeconomic groups. Some factors were fairly stable across the four datasets studied: for example, individuals were more likely to smoke if they had little or no education, regardless of if they were male or female, or lived in a low or a middle income country. Nevertheless, other factors, notably age and wealth, showed a differential effect on smoking by sex or country income level. While women in the low-income country group were twice as likely to smoke if they were in the lowest wealth quintile compared with the highest, the association was absent in the middle-income country group. CONCLUSION: Information on how smoking is distributed among low- or middle-income countries will allow policy makers to tailor future policies, and target the most vulnerable populations

Wet deposition of hydrocarbons in the city of Tehran-Iran

Air pollution in the city of Tehran has been a major problem for the past three decades. The direct effects of hydrocarbon contaminants in the air are particularly important such as their carcinogenic, mutagenic, and teratogenic effects which can be transported to other environments via dry and wet deposition. In the present study, rainwater samples were collected and analyzed for 16 polycyclic aromatic hydrocarbons (PAHs), benzene, toluene, ethyl benzene, and xylene (BTEX) as well as fuel fingerprints in two ranges of gasoline (C5–C11) and diesel fuel (C12–C20) using a gas chromatograph equipped with a flame ionization detector (GC/FID). Mean concentrations of ∑16 PAHs varied between 372 and 527 µg/L and for BTEX was between 87 and 188 µg/L with maximum of 36 µg/L for toluene. Both gasoline range hydrocarbons (GRH) and diesel range hydrocarbons (DRH) were also present in the collected rainwater at concentrations of 190 and 950 µg/L, respectively. Hydrocarbon transports from air to soil were determined in this wet deposition. Average hydrocarbon transportation for ∑PAHs, BTEX, GRH, and DRH was 2,747, 627, 1,152, and 5,733 µg/m2, respectively

Poor newborn care practices - a population based survey in eastern Uganda

BACKGROUND: Four million neonatal deaths are estimated to occur each year and almost all in low income countries, especially among the poorest. There is a paucity of data on newborn health from sub-Saharan Africa and few studies have assessed inequity in uptake of newborn care practices. We assessed socioeconomic differences in use of newborn care practices in order to inform policy and programming in Uganda. METHODS: All mothers with infants aged 1-4 months (n = 414) in a Demographic Surveillance Site were interviewed. Households were stratified into quintiles of socioeconomic status (SES). Three composite outcomes (good neonatal feeding, good cord care, and optimal thermal care) were created by combining related individual practices from a list of twelve antenatal/essential newborn care practices. Multiple logistic regression analysis was used to identify determinants of each dichotomised composite outcome. RESULTS: There were low levels of coverage of newborn care practices among both the poorest and the least poor. SES and place of birth were not associated with any of the composite newborn care practices. Of newborns, 46% had a facility delivery and only 38% were judged to have had good cord care, 42% optimal thermal care, and 57% were considered to have had adequate neonatal feeding. Mothers were putting powder on the cord; using a bottle to feed the baby; and mixing/replacing breast milk with various substitutes. Multiparous mothers were less likely to have safe cord practices (OR 0.5, CI 0.3 - 0.9) as were mothers whose labour began at night (OR 0.6, CI 0.4 - 0.9). CONCLUSION: Newborn care practices in this setting are low and do not differ much by socioeconomic group. Despite being established policy, most neonatal interventions are not reaching newborns, suggesting a "policy-to-practice gap". To improve newborn survival, newborn care should be integrated into the current maternal and child interventions, and should be implemented at both community and health facility level as part of a universal coverage strategy

Prevalence, distribution and correlates of tobacco smoking and chewing in Nepal: a secondary data analysis of Nepal Demographic and Health Survey-2006

<p>Abstract</p> <p>Background</p> <p>Nearly four-fifths of estimated 1.1 million smokers live in low or middle-income countries. We aimed to provide national estimates for Nepal on tobacco use prevalence, its distribution across demographic, socio-economic and spatial variables and correlates of tobacco use.</p> <p>Methods</p> <p>A secondary data analysis of 2006 Nepal Demographic and Health Survey (DHS) was done. A representative sample of 9,036 households was selected by two-stage stratified, probability proportional to size (PPS) technique. We constructed three outcome variables 'tobacco smoke', 'tobacco chewer' and 'any tobacco use' based on four questions about tobacco use that were asked in DHS questionnaires. Socio-economic, demographic and spatial predictor variables were used. We computed overall prevalence for 'tobacco smoking', 'tobacco chewing' and 'any tobacco use' i.e. point estimates of prevalence rates, 95% confidence intervals (CIs) after adjustment for strata and clustering at primary sampling unit (PSU) level. For correlates of tobacco use, we used multivariate analysis to calculate adjusted odds ratios (AORs) and their 95% CIs. A p-value < 0.05 was considered as significant.</p> <p>Results</p> <p>Total number of households, eligible women and men interviewed was 8707, 10793 and 4397 respectively. The overall prevalence for 'any tobacco use', 'tobacco smoking' and 'tobacco chewing' were 30.3% (95% CI 28.9, 31.7), 20.7% (95% CI 19.5, 22.0) and 14.6% (95% CI 13.5, 15.7) respectively. Prevalence among men was significantly higher than women for 'any tobacco use' (56.5% versus 19.6%), 'tobacco smoking' (32.8% versus 15.8%) and 'tobacco chewing' (38.0% versus 5.0%). By multivariate analysis, older adults, men, lesser educated and those with lower wealth quintiles were more likely to be using all forms of tobacco. Divorced, separated, and widowed were more likely to smoke (OR 1.49, 95% CI 1.14, 1.94) and chew tobacco (OR 1.36, 95% CI 0.97, 1.93) as compared to those who were currently married. Prevalence of 'tobacco chewing' was higher in eastern region (19.7%) and terai/plains (16.2%). 'Tobacco smoking' and 'any tobacco use' were higher in rural areas, mid-western and far western and mountainous areas.</p> <p>Conclusions</p> <p>Prevalence of tobacco use is considerably high among Nepalese people. Demographic and socioeconomic determinants and spatial distribution should be considered while planning tobacco control interventions.</p