Indoor air pollution from unprocessed solid fuel use and pneumonia risk in children aged under five years: a systematic review and meta-analysis
Indoor air pollution from unprocessed solid fuel use and pneumonia risk in children aged under five years: a systematic review and meta-analysis
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DOI：
10.2471/blt.07.044529
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发表时间：
2008-05-01
期刊：
影响因子：
--
通讯作者：
Bruce, Nigel
中科院分区：
文献类型：
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作者：
Dherani, Mukesh;Pope, Daniel;Bruce, Nigel
减少使用固体燃料引起的室内空气污染(IAP)暴露是预防儿童肺炎的潜在重要干预措施。这篇综述更新了先前的荟萃分析，并调查了接触未经加工的固体燃料的5岁以下儿童的风险是否因病因和肺炎严重程度而异。检索电子数据库(包括非洲、中国和拉丁美洲)，没有语言限制。检索词涵盖了IAP的所有来源和对急性下呼吸道感染的广泛描述，包括病毒和细菌剂。从主要电子数据库中的5317篇研究中(加上独立数据库中的307篇非洲和拉丁美洲研究，以及588篇中国研究)，25篇纳入综述，24篇适合进行荟萃分析。由于统计上的异质性，我们使用了随机效应模型。总体合并优势比为1.78(95%可信区间，CI：1.45-2.18)，在排除低暴露流行率(<；15%)和一个高离群值的研究后，几乎不变为1.79(95%可信区间：1.26-2.21)，并对结果的影响进行了探讨。敏感度分析评估了对照选择、混杂调整、暴露和结果评估以及年龄的影响，但没有发现明显的影响。关于呼吸道合胞病毒的证据相互矛盾，而患严重或致命肺炎的风险与所有肺炎相似或高于所有肺炎。尽管存在异质性，但这项分析显示出足够的一致性，得出结论，接触未经加工的固体燃料会使幼儿患肺炎的风险增加1.8倍。现在需要作出更大的努力来实施有效的干预措施。
Reduction of indoor air pollution (IAP) exposure from solid fuel use is a potentially important intervention for childhood pneumonia prevention. This review updates a prior meta-analysis and investigates whether risk varies by etiological agent and pneumonia severity among children aged less than 5 years who are exposed to unprocessed solid fuels. Searches were made of electronic databases (including Africa, China and Latin America) without language restriction. Search terms covered all sources of IAP and wide-ranging descriptions of acute lower respiratory infections, including viral and bacterial agents.From 5317 studies in the main electronic databases (plus 307 African and Latin American, and 588 Chinese studies, in separate databases), 25 were included in the review and 24 were suitable for meta-analysis. Due to substantial statistical heterogeneity, random effects models were used. The overall pooled odds ratio was 1.78 (95% confidence interval, CI: 1.45-2.18), almost unchanged at 1.79 (95% CI: 1.26-2.21) after exclusion of studies with low exposure prevalence (< 15%) and one high outlier There was evidence of publication bias, and the implications for the results are explored. Sensitivity subanalyses assessed the impact of control selection, adjustment for confounding, exposure and outcome assessment, and age, but no strong effects were identified. Evidence on respiratory syncytial virus was conflicting, while risk for severe or fatal pneumonia was similar to or higher than that for all pneumonia.Despite heterogeneity, this analysis demonstrated sufficient consistency to conclude that risk of pneumonia in young children is increased by exposure to unprocessed solid fuels by a factor of 1.8. Greater efforts are now required to implement effective interventions.