Control of household air pollution for child survival: estimates for intervention impacts.
Control of household air pollution for child survival: estimates for intervention impacts.
复制标题
控制儿童生存的家庭空气污染：干预影响的估计。
DOI：
10.1186/1471-2458-13-s3-s8
复制
发表时间：
2013
影响因子：
4.5
通讯作者：
Pope D
中科院分区：
文献类型：
--
作者：
Bruce NG;Dherani MK;Das JK;Balakrishnan K;Adair-Rohani H;Bhutta ZA;Pope D
使用固体燃料做饭造成的家庭空气污染(HAP)影响到发展中国家的28亿人，其中包括儿童和孕妇。这篇综述的目的是提出与HAP相关的儿童生存结果的干预估计。对0-59个月的儿童肺炎、不良妊娠结局、发育迟缓和全因死亡率进行了系统评价和荟萃分析。根据Bradford-Hill的观点对每个结果的证据进行评估，并使用等级来确定干预效果的大小，所有的优势比(OR)都被呈现为保护效果。综述发现，接触HAP与儿童ALRI、低出生体重(LBW)、死产、早产、发育迟缓和全因死亡有关。大多数研究都是观察性的，尽管对某些结果有很强的因果证据，但评级为低/非常低；只有一项随机试验合格。ALRI的干预效果(OR)估计为0.64(95%CI：0.55，0.75)，LBW的OR估计为0.71(0.65，0.79)，死产的OR估计为0.66(0.54，0.81)，其中因果证据充分。暴露-反应证据表明，这是对持续、低暴露预期的ALRI风险降低的保守估计。在一项关于早产的研究中，也发现了对发育迟缓[OR=0.79(0.70，0.89)]和[OR=0.70(0.54，0.90)]的统计学上显著的保护性OR，这表明这些结果也可能会减少。五项关于全因死亡率的研究的OR为0.79(0.70，0.89)，但异质性排除了对死亡率影响的可靠估计。尽管已有包括清洁燃料和改进固体燃料炉在内的干预措施，并可提供低暴露水平，但在低收入家庭实现持续大规模使用方面仍面临重大挑战。减少对羟基磷灰石的暴露可以大大降低几种儿童生存结果的风险，包括致命的肺炎，而拟议的效果可以通过提供低暴露的干预措施来实现。如果达到世卫组织的空气质量指南，预计会产生更大的影响。为了实现这些好处，应尽可能采用清洁燃料，并为其他家庭推广最有效的固体燃料炉。为了加强证据，需要进行新的研究，进行彻底的暴露评估，以及对干预措施的长期接受度和影响进行评估。
Exposure to household air pollution (HAP) from cooking with solid fuels affects 2.8 billion people in developing countries, including children and pregnant women. The aim of this review is to propose intervention estimates for child survival outcomes linked to HAP. Systematic reviews with meta-analysis were conducted for ages 0-59 months, for child pneumonia, adverse pregnancy outcomes, stunting and all-cause mortality. Evidence for each outcome was assessed against Bradford-Hill viewpoints, and GRADE used for certainty about intervention effect size for which all odds ratios (OR) are presented as protective effects. Reviews found evidence linking HAP exposure with child ALRI, low birth weight (LBW), stillbirth, preterm birth, stunting and all-cause mortality. Most studies were observational and rated low/very low in GRADE despite strong causal evidence for some outcomes; only one randomised trial was eligible.Intervention effect (OR) estimates of 0.64 (95% CI: 0.55, 0.75) for ALRI, 0.71 (0.65, 0.79) for LBW and 0.66 (0.54, 0.81) for stillbirth are proposed, specific outcomes for which causal evidence was sufficient. Exposure-response evidence suggests this is a conservative estimate for ALRI risk reduction expected with sustained, low exposure. Statistically significant protective ORs were also found for stunting [OR=0.79 (0.70, 0.89)], and in one study of pre-term birth [OR=0.70 (0.54, 0.90)], indicating these outcomes would also likely be reduced. Five studies of all-cause mortality had an OR of 0.79 (0.70, 0.89), but heterogenity precludes a reliable estimate for mortality impact. Although interventions including clean fuels and improved solid fuel stoves are available and can deliver low exposure levels, significant challenges remain in achieving sustained use at scale among low-income households. Reducing exposure to HAP could substantially reduce the risk of several child survival outcomes, including fatal pneumonia, and the proposed effects could be achieved by interventions delivering low exposures. Larger impacts are anticipated if WHO air quality guidelines are met. To achieve these benefits, clean fuels should be adopted where possible, and for other households the most effective solid fuel stoves promoted. To strengthen evidence, new studies with thorough exposure assessment are required, along with evaluation of the longer-term acceptance and impacts of interventions.