Long term impacts of combined sewer overflow remediation on water quality and population dynamics of Culex quinquefasciatus, the main urban West Nile virus vector in Atlanta, GA

Background: Combined sewers are a significant source of urban water pollution due to periodic discharges into natural streams. Such events (called combined sewer overflows, or CSOs) contribute to the impairment of natural waterways and are associated with increased mosquito productivity and elevated risk of West Nile virus transmission.\ud \ud Objectives: We investigated the impact of CSOs on water quality and immature mosquito productivity in the city of Atlanta, Georgia, one year before and four years after CSO facility remediation.\ud \ud Methods: Water quality (ammonia, phosphate, nitrate and dissolved oxygen concentrations), immature mosquitoes (larvae and pupae), water temperature and rainfall were quantified biweekly between June–October at two urban creeks during 2008–2012. A before–after control–intervention design tested the impact of remediation on mosquito productivity and water quality, whereas generalized linear mixed-effect models quantified the factors explaining the long term impacts of remediation on mosquito productivity.\ud \ud Results: Ammonia and phosphate concentrations and late immature (fourth-instar and pupae) mosquito populations were significantly higher in CSO than in non-CSO creeks, while dissolved oxygen concentrations were lower. Remediation significantly improved water quality estimates (particularly ammonia and dissolved oxygen) and reduced the number of overflows, mosquito productivity and the overall contribution of CSO-affected streams as sources of vectors of West Nile virus.\ud \ud Conclusions: The quality of water in CSOs provided a suitable habitat for immature mosquitoes. Remediation of the CSO facility through the construction of a deep storage tunnel improved water quality indices and reduced the productivity of mosquito species that can serve as vectors of West Nile virus

Cross-sectional analysis of the association between personal exposure to household air pollution and blood pressure in adult women: Evidence from the multi-country Household Air Pollution Intervention Network (HAPIN) trial

Elevated blood pressure (BP) is a leading risk factor for the global burden of disease. Household air pollution (HAP), resulting from the burning of biomass fuels, may be an important cause of elevated BP in resource-poor communities. We examined the exposure-response relationship of personal exposures to HAP —fine particulate matter (PM(2.5)), carbon monoxide (CO), and black carbon (BC) — with BP measures in women aged 40–79 years across four resource-poor settings in Guatemala, Peru, India and Rwanda. BP was obtained within a day of 24-h personal exposure measurements at baseline, when participants were using biomass for cooking. We used generalized additive models to characterize the shape of the association between BP and HAP, accounting for the interaction of personal exposures and age and adjusting for a priori identified confounders. A total of 418 women (mean age 52.2 ± 7.9 years) were included in this analysis. The interquartile range of exposures to PM(2.5) was 42.9–139.5 μg/m(3), BC was 6.4–16.1 μg/m(3), and CO was 0.5–2.9 ppm. Both SBP and PP were positively associated with PM(2.5) exposure in older aged women, achieving statistical significance around 60 years of age. The exact threshold varied by BP measure and PM(2.5) exposures being compared. For example, SBP of women aged 65 years was on average 10.8 mm Hg (95% CI 1.0–20.6) higher at 232 μg/m(3) of PM(2.5) exposure (90th percentile) when compared to that of women of the same age with personal exposures of 10 μg/m(3). PP in women aged 65 years was higher for exposures ≥90 μg/m(3), with mean differences of 6.1 mm Hg (95% CI 1.8–10.5) and 9.2 mm Hg (95% CI 3.3–15.1) at 139 (75th percentile) and 232 μg/m(3) (90th percentile) respectively, when compared to that of women of the same age with PM(2.5) exposures of 10 μg/m(3). Our findings suggest that reducing HAP exposures may help to reduce BP, particularly among older women

Designing a comprehensive behaviour change intervention to promote and monitor exclusive use of liquefied petroleum gas stoves for the Household Air Pollution Intervention Network (HAPIN) trial

Introduction Increasing use of cleaner fuels, such as liquefied petroleum gas (LPG), and abandonment of solid fuels is key to reducing household air pollution and realising potential health improvements in low-income countries. However, achieving exclusive LPG use in households unaccustomed to this type of fuel, used in combination with a new stove technology, requires substantial behaviour change. We conducted theory-grounded formative research to identify contextual factors influencing cooking fuel choice to guide the development of behavioural strategies for the Household Air Pollution Intervention Network (HAPIN) trial. The HAPIN trial will assess the impact of exclusive LPG use on air pollution exposure and health of pregnant women, older adult women, and infants under 1 year of age in Guatemala, India, Peru, and Rwanda.Methods Using the Capability, Opportunity, Motivation–Behaviour (COM–B) framework and Behaviour Change Wheel (BCW) to guide formative research, we conducted in-depth interviews, focus group discussions, observations, key informant interviews and pilot studies to identify key influencers of cooking behaviours in the four countries. We used these findings to develop behavioural strategies likely to achieve exclusive LPG use in the HAPIN trial.Results We identified nine potential influencers of exclusive LPG use, including perceived disadvantages of solid fuels, family preferences, cookware, traditional foods, non-food-related cooking, heating needs, LPG awareness, safety and cost and availability of fuel. Mapping formative findings onto the theoretical frameworks, behavioural strategies for achieving exclusive LPG use in each research site included free fuel deliveries, locally acceptable stoves and equipment, hands-on training and printed materials and videos emphasising relevant messages. In the HAPIN trial, we will monitor and reinforce exclusive LPG use through temperature data loggers, LPG fuel delivery tracking, in-home observations and behavioural reinforcement visits.Conclusion Our formative research and behavioural strategies can inform the development, implementation, monitoring and evaluation of theory-informed strategies to promote exclusive LPG use in future stove programmes and research studies.Trial registration number NCT02944682, Pre-results

Comparison of next-generation portable pollution monitors to measure exposure to PM2.5 from household air pollution in Puno, Peru

Assessment of personal exposure to PM2.5 is critical for understanding intervention effectiveness and exposure-response relationships in household air pollution studies. In this pilot study, we compared PM2.5 concentrations obtained from two next-generation personal exposure monitors (the Enhanced Children MicroPEM or ECM; and the Ultrasonic Personal Air Sampler or UPAS) to those obtained with a traditional Triplex Cyclone and SKC Air Pump (a gravimetric cyclone/pump sampler). We co-located cyclone/pumps with an ECM and UPAS to obtain 24-hour kitchen concentrations and personal exposure measurements. We measured Spearmen correlations and evaluated agreement using the Bland-Altman method. We obtained 215 filters from 72 ECM and 71 UPAS co-locations. Overall, the ECM and the UPAS had similar correlation (ECM rho = 0.91 vs UPAS rho = 0.88) and agreement (ECM mean difference of 121.7 mu g/m(3) vs UPAS mean difference of 93.9 mu g/m(3)) with overlapping confidence intervals when compared against the cyclone/pump. When adjusted for the limit of detection, agreement between the devices and the cyclone/pump was also similar for all samples (ECM mean difference of 68.8 mu g/m(3) vs UPAS mean difference of 65.4 mu g/m(3)) and personal exposure samples (ECM mean difference of -3.8 mu g/m(3) vs UPAS mean difference of -12.9 mu g/m(3)). Both the ECM and UPAS produced comparable measurements when compared against a cyclone/pump setup