1/2-Bangladesh Center for Global Environmental and Occupational Health- Bangladesh

项目摘要 全世界近30亿人，包括89%的孟加拉国人，暴露于有害的环境中。 家庭空气污染物（HAP）排放的生物质（木材，农业残留物，牛粪， 等等）。燃料用于烹饪。虽然与空气污染有关的健康风险已得到相当充分的研究， 在发达国家，几乎没有证据表明通过清洁燃料减少HAP可以带来健康益处 特别是在低收入和中等收入国家（LMIC）。孟加拉国GEOHealth中心建立了一个 生物质燃料使用者队列（n=660）。我们观察到HAP暴露的增加与肺 功能下降、血压升高以及先天性和适应性免疫功能的破坏。我们 观察到24小时内使用专用液化石油气（LPG）炉灶可大幅减少HAP暴露 几个月，导致妇女和儿童的免疫和炎症反应发生变化。然而，在这方面， 由于随访时间短，慢性心肺标志物的变化具有挑战性。在 寻求创新的成本效益，适应性强，可扩展的干预作为可能的下一步，我们 计划通过使用移动的教育干预进行一项大型家庭水平的随机对照试验 手机（mHealth）技术。此外，我们将继续跟踪队列，并进行严格的 以及对PM2.5和黑碳（BC）的重复个性化（24-48小时）和区域（5天以上）评估 暴露，以检查HAP减少对心肺功能亚临床指标的长期影响， 免疫功能障碍，包括HAP暴露对疫苗抗体应答的影响。我们还将使用深度 学习识别HAP相关肺部病理的方法。最后，我们提出了两个探索性的研究， 工业废物和制衣业工作对健康的影响。这项研究的目的在科学上是重要的 与政策直接相关，并与GEOHealth计划议程一致。 1

PROJECT SUMMARY Almost 3 billion people worldwide, including 89% people in Bangladesh, are exposed to harmful household air pollutants (HAP) emitted from combustion of biomass (wood, agricultural residue, cow dung, etc.) fuel use for cooking. While health risks associated with air-pollution have been reasonably well-studied in developed countries, there is little evidence on health benefits achievable by HAP reduction through clean fuel use, especially in low- and middle-income countries (LMICs). Bangladesh GEOHealth hub has established a cohort of biomass fuel users (n=660). We observed that an increased HAP exposure was associated with lung function decline, increased blood pressure and disruption of innate and adaptive immune function. We observed a drastic reduction in HAP exposure by exclusive liquified petroleum gas (LPG) stove use for 24 months, resulting changes in immune and inflammatory responses in women and in children. However, changes in chronic cardio-pulmonary markers were challenging mostly due to short duration of follow up. In quest for an innovative cost effective, adaptable, and scalable intervention as the possible next step, we planned to conduct a large household level randomized controlled trial by educational intervention using mobile phone (mHealth) based technology. In addition, we will continue following the cohort and will conduct rigorous and repeated personalized (24-48 hours) and area (over 5 days) assessments of PM2.5 and black carbon (BC) exposure to examine the long-term effects of HAP reduction on subclinical measures of cardio-pulmonary and immune dysfunction including effect of HAP exposure on antibody response to vaccine. We will also use deep learning methods to identify lung pathology in relation to HAP. Finally, we propose two exploratory studies on health effects of industrial waste and garment industry work. The aims of this study are scientifically important and directly policy-relevant and consistent with the GEOHealth program agenda. 1