Exposure-response relationship of residential dampness and mold damage with severe lower respiratory tract infections among under-five children in Nigeria

Adekunle Gregory Fakunle; Nkosana Jafta; Akinkunmi Paul Okekunle; Lidwien A M Smit; Rajen N Naidoo

doi:10.1097/EE9.0000000000000247

Exposure-response relationship of residential dampness and mold damage with severe lower respiratory tract infections among under-five children in Nigeria

Environ Epidemiol. 2023 Mar 29;7(2):e247. doi: 10.1097/EE9.0000000000000247. eCollection 2023 Apr.

Authors

Adekunle Gregory Fakunle^{1

2}, Nkosana Jafta², Akinkunmi Paul Okekunle³, Lidwien A M Smit⁴, Rajen N Naidoo²

Affiliations

¹ Department of Public Health, College of Health Sciences. Osun State University, Osogbo, Nigeria, Osogbo, Nigeria.
² Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa.
³ Department of Food and Nutrition, Seoul National University, Seoul, Korea.
⁴ Institute for Risk Assessment Sciences (IRAS), Utrecht University, The Netherlands.

Abstract

Previous epidemiological studies demonstrated an increased risk of respiratory health effects in children and adults exposed to dampness or mold. This study investigated associations of quantitative indicators of indoor dampness and mold exposure with severe lower respiratory tract infections (LRTI) among children aged 1-59 months in Ibadan, Nigeria.

Methods: In-home visits were conducted among 178 children hospitalized with LRTI matched by age (±3 months), sex, and geographical location with 180 community-based children without LRTI. Trained study staff evaluated the indoor environment using a standardized home walkthrough checklist and measured visible dampness and mold damage. Damp-moldy Index (DMI) was also estimated to quantify the level of exposure. Exposure-response relationships of dampness and mold exposure with severe LRTI were assessed using multivariable restricted cubic spline regression models adjusting for relevant child, housing, and environmental characteristics.

Results: Severe LRTI cases were more often male than female (61.8%), and the overall mean (SD) age was 7.3 (1.35) months. Children exposed to dampness <0.3 m² (odds ratio [OR] = 2.11; 95% confidence interval [CI] = 1.05, 4.36), and between 0.3 and 1.0 m² (OR = 2.34; 95% CI = 1.01, 7.32), had a higher odds of severe LRTI compared with children not exposed to dampness. The restricted cubic spline showed a linear exposure-response association between severe LRTI and residential dampness (P < 0.001) but a nonlinear relationship with DMI (P = 0.01).

Conclusions: Residential dampness and DMI were exposure-dependently associated with higher odds of severe LRTI among under-five children. If observed relationships were causal, public health intervention strategies targeted at reducing residential dampness are critically important to mitigate the burden of severe LRTI among under-five children.

Keywords: Dampness; Nigeria; epidemiology; lower respiratory tract infections; mold exposure; under-five children.