Digital Auscultation and Pulmonary Function Testing Among Rural Bangladeshi Infants

孟加拉国农村婴儿的数字听诊和肺功能测试

• 批准号: 9922276
• 负责人: Eric Douglass McCollum
• 金额: $ 9.24万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9922276
• 关键词: 5 year old; Acute; Affect; Age; Age-Months; Agreement; Air Pollution; American; Area; Asthma; Auscultation; Bangladesh; Bangladeshi; Biomass; Birth; Breathing; Caliber; Caring; Cause of Death; Cessation of life; Chest; Child; Child Health; Childhood; Childhood Asthma; Chronic; Chronic lung disease; Clinical; Clinical Research; Cohort Studies; Communities; Community Health Aides; Complex; Computer Analysis; Cookstove; Crackles; Data; Diagnosis; Diagnostic; Dose; Effectiveness; European; Exhalation; Exploratory/Developmental Grant for Diagnostic Cancer Imaging; Exposure to; Future; Gases; Goals; Health; Health Benefit; Heating; Hospitals; Hour; Household; Household Air Pollution; Human; Incidence; Infant; International; Intervention; Laboratories; Lighting; Literature; Longitudinal cohort; Lung; Lung diseases; Measurement; Methodology; Methods; National Institute of Environmental Health Sciences; Nitric Oxide; Outcome; Particulate Matter; Pneumonia; Population; Pregnant Women; Prevalence; Pulmonary function tests; Reference Values; Research; Resources; Respiratory Sounds; Respiratory physiology; Risk; Rural; Rural Community; Rural Health; Sleep; Smoke; Societies; Source; Stethoscopes; Techniques; Translational Research; Uncertainty; Validation; Wheezing; Woman; World Health Organization; airway inflammation; base; biomass fuel; burden of illness; cohort; computerized; cooking; diagnostic accuracy; digital; experience; improved; indexing; indoor pollutant; infant monitoring; infection risk; innovation; low and middle-income countries; lung injury; mortality; novel; pollutant; premature; prenatal; prenatal exposure; respiratory; respiratory health; response; rural area; sound; stem

PROJECT SUMMARY: This is a re-submission for a National Institute of Environmental Health Sciences R21 award aiming to comprehensively evaluate digital auscultation and pulmonary function testing among Bangladeshi infants as innovative respiratory outcomes for future air pollution research in low-middle income countries (LMICs). Household air pollution (HAP) is the number one environmental cause of death worldwide and disproportionally affects the health of rural women and children in LMICs like Bangladesh. Particulate matter with an aerodynamic diameter <2.5 µm (PM2.5) is an important indoor pollutant that is primarily generated by biomass fuel use during cooking, heating, and lighting. Elevated PM2.5 exposure has been associated with a substantially increased risk of child pneumonia mortality, the leading cause of infectious death in children globally, and childhood asthma incidence, the number one chronic lung disease among children worldwide. To date LMIC HAP research aiming to evaluate respiratory outcomes in children associated with PM2.5 exposure has focused on the acute endpoint of World Health Organization-defined pneumonia, a diagnosis known as poorly accurate and highly non-specific for studying pediatric respiratory health effects attributable to HAP. We aim to generate evidence supporting digital auscultation and pulmonary function testing as feasible, innovative, and diagnostically accurate pediatric respiratory health outcomes for inclusion in future LMIC HAP research within the rural communities most affected by HAP. To accomplish this overall goal we will conduct a longitudinal birth cohort study among 400 rural Bangladeshi pregnant women and their infants until the age of two months. For Aim 1 we will systematically evaluate lung sound recording quality by community health workers using a novel digital stethoscope during their care of rural Bangladeshi infants. We hypothesize that >90% of sounds will meet quality criteria, high interpretation agreement will be achieved between human listeners and also between automated computer analysis and humans, and that elevated prenatal PM2.5 concentrations will be associated with a higher incidence of abnormal digitally recorded lung sounds among infants. For Aim 2 we will create population reference values and evaluate the feasibility and validity of non-invasive, unsedated lung function testing of rural Bangladeshi two month old infants. We hypothesize that >90% of measurements will meet international validation criteria, infant lung function testing will be feasible, and that prenatal exposure to elevated PM2.5 concentrations will be associated with lower infant lung function. Successful completion of the research described in this application will dramatically advance the methodology for accurate assessment of acute and chronic child respiratory outcomes for future LMIC HAP research, and can also serve as crosscutting methods suitable for resource-rich settings and non-HAP research in LMICs.

项目总结： 这是对美国国家环境健康科学研究所R21奖项的重新提交，旨在 孟加拉婴幼儿数字听诊和肺功能检测的综合评价 创新的呼吸结果，用于中低收入国家未来的空气污染研究。 家庭空气污染(HAP)是全球范围内导致死亡的头号环境原因，而且比例不均。 影响孟加拉国等低收入国家农村妇女和儿童的健康。颗粒物中含有 空气动力学直径2.5微米(PM2.5)是一种重要的室内污染物，主要由生物质产生 烹饪、取暖和照明过程中的燃料使用。PM2.5暴露增加与 儿童肺炎死亡风险大幅增加，肺炎是儿童感染性死亡的主要原因 全球，以及儿童哮喘发病率，这是全球儿童中头号慢性肺部疾病。至 旨在评估与PM2.5暴露相关的儿童呼吸结果的LMIC HAP研究日期 专注于世界卫生组织定义的肺炎的急性终点，这种诊断被称为 对于研究可归因于HAP的儿科呼吸健康影响，精确度较差且高度非特异性。 我们的目标是在可行的情况下产生支持数字听诊和肺功能测试的证据， 创新且诊断准确的儿科呼吸健康结果将纳入未来的LMIC HAP 在受HAP影响最严重的农村社区内进行研究。为了实现这一总体目标，我们将进行一项 400名孟加拉农村孕妇及其婴儿出生年龄纵向队列研究 两个月。对于目标1，我们将按社区系统地评估肺录音质量。 卫生工作者在护理孟加拉农村婴儿时使用新型数字听诊器。我们 假设&gt；90%的声音符合质量标准，将实现高度的口译一致性 在人类听众之间，也在自动计算机分析和人类之间， 产前PM2.5浓度将与数字记录的肺异常发生率更高相关 在婴儿中发出的声音。对于目标2，我们将创建人口参考值并评估其可行性 孟加拉农村地区两个月大婴儿非侵入性、非镇静剂肺功能检测的有效性 婴儿。我们假设90%的测量结果将符合国际认证标准，婴儿肺 功能测试将是可行的，产前暴露于升高的PM2.5浓度将与 婴儿肺功能较低。 成功完成本申请中描述的研究将极大地推动方法学的发展 对于未来LMIC HAP研究的急性和慢性儿童呼吸结局的准确评估，以及 也可以作为横切方法，适用于资源丰富的环境和LMIC中的非HAP研究。