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Non-communicable respiratory disease and air pollution exposure in Malawi: a prospective cohort study

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Rylance, Sarah, Jewell, Chris, Naunje, Andrew, Mbalume, Frank, Chetwood, John, Nightingale, Rebecca, Zurba, Lindsay, Flitz, Graham, Gordon, Stephen ORCID: https://orcid.org/0000-0001-6576-1116, Lesosky, Maia, Balmes, John and Mortimer, Kevin ORCID: https://orcid.org/0000-0002-8118-8871 (2020) 'Non-communicable respiratory disease and air pollution exposure in Malawi: a prospective cohort study'. Thorax, Vol 75, Issue 3, pp. 220-226.

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Abstract

Rationale: There are no population-based studies from sub-Saharan Africa describing longitudinal lung function in adults. Objectives: To explore the lung function trajectories and their determinants, including the effects of air pollution exposures and the cleaner-burning biomass-fuelled cookstove intervention of the Cooking and Pneumonia Study (CAPS), in adults living in rural Malawi. Methods: We assessed respiratory symptoms and exposures, spirometry and measured 48-hour personal exposure to fine particulate matter (PM2.5) and carbon monoxide (CO), on three occasions over 3 years. Longitudinal data were analysed using mixed-effects modelling by maximum likelihood estimation. Measurements and main results: We recruited 1481 adults, mean (SD) age 43.8 (17.8) years, including 523 participants from CAPS households (271 intervention; 252 controls), and collected multiple spirometry and air pollution measurements for 654 (44%) and 929 (63%), respectively. Compared with Global Lung Function Initiative African-American reference ranges, mean (SD) FEV1 (forced expiratory volume in 1 s) and FVC (forced vital capacity) z-scores were −0.38 (1.14) and −0.19 (1.09). FEV1 and FVC were determined by age, sex, height, previous TB and body mass index, with FEV1 declining by 30.9 mL/year (95% CI: 21.6 to 40.1) and FVC by 38.3 mL/year (95% CI: 28.5 to 48.1). There was decreased exposure to PM2.5 in those with access to a cookstove but no effect on lung function. Conclusions: We did not observe accelerated lung function decline in this cohort of Malawian adults, compared with that reported in healthy, non-smoking populations from high-income countries; this suggests that the lung function deficits we measured in adulthood may have origins in early life.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WA Public Health > Air pollution > WA 754 Pollution and pollutants (incl. tobacco pollution; passive smoking)
WC Communicable Diseases > Infection. Bacterial Infections > Bacterial Infections > WC 202 Pneumonia (General or not elsewhere classified)
WF Respiratory System > WF 140 Diseases of the respiratory system (General)
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW)
Education
Digital Object Identifer (DOI): https://doi.org/10.1136/thoraxjnl-2019-213941
Depositing User: Julie Franco
Date Deposited: 24 Feb 2020 12:21
Last Modified: 22 Jul 2020 11:34
URI: https://archive.lstmed.ac.uk/id/eprint/13511

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