title: The exposure of infants and children to carbon monoxide from biomass fuels in The Gambia: a measurement and modeling study.
abstract: Smoke from biomass fuels is a risk factor for pneumonia, the leading cause of child death worldwide. Although particulate matter (PM) is the metric of choice for studying the health effects of biomass smoke, measuring children's PM exposure is difficult. Carbon monoxide (CO), which is easier to measure, can be used as a proxy for PM exposure. We measured the exposure of children ≤ 5 years of age in The Gambia to CO using small, passive, color stain diffusion tubes. We conducted multiple CO measurements on a subset of children to measure day-to-day exposure variability. Usual CO exposure was modeled using a mixed effects model, which also included individual and household level exposure predictors. Mean measured CO exposure for 1181 children (n=2263 measurements) was 1.04 ± 1.46 p.p.m., indicating that the Gambian children in this study on average have a relatively low CO exposure. However, 25% of children had exposures of 1.3 p.p.m. or higher. CO exposure was higher during the rainy months (1.33 ± 1.62 p.p.m.). Burning insect coils, using charcoal, and measurement done in the rainy season were associated with higher exposure. A parsimonious model with fuel, season, and other PM sources as covariates explained 39% of between-child variation in exposure and helped remove within-child variability.
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Kathie L
authors.initials: KL
authors.lastname: Dionisio
authors.forename: Stephen R C
authors.initials: SR
authors.lastname: Howie
authors.forename: Francesca
authors.initials: F
authors.lastname: Dominici
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Fornace
authors.forename: John D
authors.initials: JD
authors.lastname: Spengler
authors.forename: Simon
authors.initials: S
authors.lastname: Donkor
authors.forename: Osaretin
authors.initials: O
authors.lastname: Chimah
authors.forename: Claire
authors.initials: C
authors.lastname: Oluwalana
authors.forename: Readon C
authors.initials: RC
authors.lastname: Ideh
authors.forename: Bernard
authors.initials: B
authors.lastname: Ebruke
authors.forename: Richard A
authors.initials: RA
authors.lastname: Adegbola
authors.forename: Majid
authors.initials: M
authors.lastname: Ezzati
mesh_terms: D000393:Air Pollutants / Q000009:adverse effects / Q000032:analysis*; D016902:Air Pollution, Indoor / Q000009:adverse effects / Q000032:analysis*; D056804:Biofuels / Q000009:adverse effects / Q000032:analysis*; D018533:Biomass; D002248:Carbon Monoxide / Q000009:adverse effects / Q000032:analysis*; D002675:Child, Preschool; D003296:Cooking; D004781:Environmental Exposure / Q000009:adverse effects / Q000032:analysis*; D004784:Environmental Monitoring / Q000379:methods; D005714:Gambia; D006801:Humans; D016014:Linear Models; D052638:Particulate Matter / Q000009:adverse effects / Q000032:analysis; D011014:Pneumonia / Q000209:etiology; D012621:Seasons; D012906:Smoke / Q000032:analysis; D011795:Surveys and Questionnaires
chemical_list: D000393:Air Pollutants; D056804:Biofuels; D052638:Particulate Matter; D012906:Smoke; D002248:Carbon Monoxide