Ambient and indoor air pollution exposure and adverse birth outcomes in Adama, Ethiopia

Erin Flanagan; Anna Oudin; John Walles; Asmamaw Abera; Kristoffer Mattisson; Christina Isaxon; Ebba Malmqvist

doi:10.1016/j.envint.2022.107251

Ambient and indoor air pollution exposure and adverse birth outcomes in Adama, Ethiopia

Environ Int. 2022 Jun:164:107251. doi: 10.1016/j.envint.2022.107251. Epub 2022 Apr 20.

Authors

Erin Flanagan¹, Anna Oudin², John Walles³, Asmamaw Abera⁴, Kristoffer Mattisson², Christina Isaxon⁵, Ebba Malmqvist²

Affiliations

¹ Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden. Electronic address: erin.flanagan@med.lu.se.
² Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden.
³ Clinical Infection Medicine, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden.
⁴ Ethiopia Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia.
⁵ Division of Ergonomics and Aerosol Technology, Department of Design Sciences, Faculty of Engineering, LTH, Lund University, Lund, Sweden.

PMID: 35533531
DOI: 10.1016/j.envint.2022.107251

Abstract

Air pollution poses a threat to human health, with pregnant women and their developing fetuses being particularly vulnerable. A high dual burden of ambient and indoor air pollution exposure has been identified in Ethiopia, but studies investigating their effects on adverse birth outcomes are currently lacking. This study explores the association between ambient air pollution (NO_X and NO₂) and indoor air pollution (cooking fuel type) and fetal and neonatal death in Adama, Ethiopia. A prospective cohort of mothers and their babies was used, into which pregnant women were recruited at their first antenatal visit (n = 2085) from November 2015 to February 2018. Previously developed land-use regression models were utilized to assess ambient concentrations of NO_X and NO₂ at the residential address, whereas data on cooking fuel type was derived from questionnaires. Birth outcome data was obtained from self-reported questionnaire responses during the participant's postnatal visit or by phone if an in-person meeting was not possible. Binary logistic regression was employed to assess associations within the final study population (n = 1616) using both univariate and multivariate models; the latter of which adjusted for age, education, parity, and HIV status. Odds ratios (OR) and their corresponding 95% confidence intervals (CI) were reported. Within the cohort, 69 instances of fetal death (n = 16 miscarriages; n = 53 stillbirths) and 16 cases of neonatal death were identified. The findings suggest a tendency towards an association between ambient NO_X and NO₂ exposure during pregnancy and an increased risk of fetal death overall as well as stillbirth, specifically. However, statistical significance was not observed. Results for indoor air pollution and neonatal death were inconclusive. As limited evidence on the effects of exposure to ambient air pollution on adverse birth outcomes exists in Sub-Saharan Africa and Ethiopia, additional studies with larger study populations should be conducted.

Keywords: Ambient air pollution; Birth outcomes; Cooking fuel; Fetal death; Indoor air pollution; Neonatal death.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Air Pollutants* / toxicity
Air Pollution* / adverse effects
Air Pollution, Indoor* / adverse effects
Air Pollution, Indoor* / analysis
Ethiopia / epidemiology
Female
Humans
Infant, Newborn
Nitrogen Dioxide / adverse effects
Particulate Matter / toxicity
Perinatal Death*
Pregnancy
Prospective Studies
Stillbirth / epidemiology

Substances

Air Pollutants
Particulate Matter
Nitrogen Dioxide