Dr. Archana Patel, MD, DNB (Pediatrics), MSCE, PhD , Chief ...

Lata Medical Research Foundation LMRF

Dr. Archana Patel, MD, DNB (Pediatrics), MSCE, PhD ,

Chief Functionary Officer (CFO) and Vice President, Lata Medical Research Foundation,

Ex- Professor of Pediatrics Indira Gandhi Government Medical College

Nagpur – 440018, India


Impact of Exposure to Household Air Pollution (HAP)on Stillbirths, Perinatal,

Very Early and Late Neonatal Mortality- a multicenter prospective cohort study

in rural communities in India, Pakistan, Kenya, Zambia and Guatemala

Archana Patel, Patricia Hibberd, NICHD’s Global Network Group.

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Lata Medical Research Foundation LMRF Background

In a large multi-country observational study, we examined whether exposure to HAP was associated with perinatal mortality (stillbirths from gestation week 20and deaths through day7 of life) as well as when the deaths occurred (macerated, non-macerated stillbirths, very early neonatal mortality (day 0-2) and later neonatal mortality (day 3-28).

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Lata Medical Research Foundation LMRF Methods

The study was conducted between May 2011 and October 2012.

Questions about household fuel use were added to

pregnancy, labor and delivery and neonatal data collection

Polluting fuels included kerosene, charcoal, coal, wood,

straw, crop waste and dung. Clean fuels included electricity, liquefied petroleum gas (LPG) and natural gas.

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Global Network Sites

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Lata Medical Research Foundation LMRF Study Flow Diagram

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Enrolled N=69,705 (99.6%)

Exclusions (N=2,847 (5%))

Miscarriages: N=1102 Multiple gestation: N=919 Termination of pregnancy: N=440 Lost to follow-up: N=336 Day 7 Outcome missing: N=33 Maternal Age missing: N=10 Maternal Parity missing: N=7

Singleton Pregnancies Analyzed N=54,082 (77%)

Singleton Pregnancies Analyzed N=11,830 (93%)

Exclusions (N=946 (7%)) Miscarriages: N=422 Multiple gestation: N=216 Delivery data missing: N=113 Termination of pregnancy: N=188 Day 7 Outcome missing: N=7 Maternal Age missing: N=0 Maternal Parity missing: N=0

Households Using Polluting Fuel

N=56,929 (82%)

Household Using Clean Fuel

N=12,776 (18%)

Eligible Pregnant Women N=70,016 (100%)

Exclusions (N=311 (0.4%))

Other fuel type: N=283 Fuel type missing: N=28

Lata Medical Research Foundation LMRF Results

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Fuel Use by Global Network Site


Characteristic

Perinatal Mortality (through day 7 of

life) N=3,176 n (%)

Alive on day 8 of life

N=62,736 n (%)

Relative Risk Adjusted for Global Network Site

and Community (95% CI)

Multivariate Analysis -

Adjusted Relative Risk

(95% CI)

HAP exposure 3,176 62,736

Polluting Fuel 2,683 (84) 51,399 (82) 1.36 (1.25, 1.49) 1.44 (1.30, 1.61)

Clean Fuel 493 (16) 11,337 (18) 1.00 1.00

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Table 1: Risk Factors for Perinatal Mortality

* Adjusted for Maternal age, Education, Parity, Antenatal Care, Delivery attendant, delivery location, infant gender, daily smoking in the household


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Table 2: Risk Factors for the Multilevel Mortality Variable Characteristic

Multivariate Analysis - Adjusted Odds Ratios (95% Confidence Interval)

Macerated Stillbirths

Non-Macerated Stillbirths

Early Neonatal Mortality day 0-2 of life (NMR_0-2)

Later Neonatal Mortality Day

3-28 of life (NMR_3-28)

Alive on Day 29 (Reference

Group)

HAP exposure

Polluting Fuel 1.66 (1.23, 2.25) 1.43 (1.15, 1.85) 1.82 (1.47, 2.22) 1.28 (0.91, 1.76) 1.00

Clean Fuel 1.00 1.00 1.00 1.00 1.00

Table 2: Risk Factors for the Multilevel Mortality Variable

* Adjusted for Maternal age, Education, Parity, Antenatal Care, Delivery attendant, delivery location, infant gender, daily smoking in the household

Lata Medical Research Foundation LMRF Conclusion

Perinatal mortality was associated with

exposure to HAP from week 20 of pregnancy through at least day 2 of life. Since pregnancy losses before labor and delivery are difficult to track, the effect of exposure to polluting fuels on fetal losses may have been underestimated.

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Does smoke from biomass fuel contribute to anemia in pregnant women in Nagpur, India? A cross-

sectional study

Charlotte M. Page, Archana Patel, Patricia L. Hibberd

Lata Medical Research Foundation LMRF Background

We hypothesized that exposure to smoke from

biomass fuel– which is widely used for household

energy needs in resource-limited settings – could

exacerbate anemia in pregnancy, possibly as a

result of systemic inflammation

Lata Medical Research Foundation LMRF Objective

To evaluate whether exposure to smoke from

biomass fuel (wood, straw, crop residues, or

dung) as opposed to clean fuel (electricity,

liquefied petroleum gas, natural gas, or biogas)

is an independent risk factor for anemia in

pregnancy, classified by severity. 14/04/15 13


A secondary analysis was performed using data collected from a rural pregnancy cohort (N=12,782) in Nagpur, India in 2011-2013 as part of the NIH-funded Maternal and Newborn Health Registry Study.

Multinomial logistic regression was used to estimate the effect of biomass

fuel vs. clean fuel use on anemia in pregnancy, controlling for §  maternal age, §  body mass index, §  education level, §  exposure to household tobacco smoke, §  parity, §  trimester when hemoglobin was measured, and §  receipt of prenatal iron and folate supplements

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Table 3. Multivariate analysis of risk factors for anemia in pregnant women in Nagpur, India, 2011-2013: multivariate, multinomial logistic regression model.

•  *Baseline category •  ‡ Differs significantly from 1 at the 95% confidence level •  Abbreviations: RRR = relative risk ratio, 95% CI = 95% confidence interval, BMI = body mass index. •  Adjusted for co-variates- Education, exposure to household tobaco smoke, Parity, Trimester, Prenatal iron and

folic acid supplementation

Mild anemia Moderate-to-severe anemia

Risk factor Category RRR 95% CI RRR 95% CI

Fuel type Clean fuel 1.00* 1.00*

Biomass fuel 1.38 1.19-1.61‡ 1.79 1.53-2.09‡

Age (years) - 0.95 0.93-0.98‡ 0.94 0.91-0.96‡

BMI (kg/m2) - 0.92 0.90-0.94‡ 0.83 0.81-0.86‡

Lata Medical Research Foundation LMRF Conclusion

In our study population, exposure to

biomass smoke was associated with higher risks of mild and moderate-to-severe anemia in pregnancy, independent of covariates.

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THANK YOU

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Dr. Archana Patel, MD, DNB (Pediatrics), MSCE, PhD , Chief ...

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