title: Work as a street vendor, associated traffic-related air pollution exposures and risk of adverse pregnancy outcomes in Accra, Ghana.
abstract: BACKGROUND
  Street vending, a dominant occupation in urban areas of developing countries exposes the vendors to several environmental pollutants. We investigated whether work as street vendor impairs foetal growth and shortens gestational duration, and evaluated to what extent exposure to traffic-related air pollution is responsible for these adverse effects.
  
  
  METHODS
  A cross-sectional study was conducted among mothers and their newborns accessing postnatal services at the Korle Bu Teaching Hospital in Accra, Ghana in 2010, focusing on 105 street vendors and a reference group of 281 mothers. We categorized exposure to traffic-related air pollution on the basis of street vending activity patterns and traffic density in the working area.
  
  
  RESULTS
  Multivariate linear regression analysis adjusting for age, social class, marital status and gravidity of mothers, sex of neonate, and indoor air pollution, indicated a 177 g (95% CI: 324, 31) reduction in birth weight among street vendors. Sensitivity analysis performed by restricting the analysis to term births showed further reductions in birth weight. Generalized linear models adjusting for confounders indicated a 35% (risk ratio (RR)=1.35; 95% CI: 0.87, 2.12) increased risk of LBW, albeit statistically not significant. LBW risk increased in the sensitivity analysis but was also not statistically significant. The risk of PTB was not associated with street vending (RR=1.03; 95% CI: 0.67, 1.58). The exposure-response relations observed were not consistent. Moderate activity patterns and high traffic density jointly was associated with a statistically significant 84% (RR=1.84; 95% CI: 1.05, 3.24) increased risk of LBW.
  
  
  CONCLUSIONS
  Street vending during pregnancy is a determinant of average foetal growth and risk of LBW. More research is required to further quantify their effects on pregnancy outcomes and safeguard maternal and perinatal health in developing countries.
authors: Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland; Public Health, Institute of Health Sciences, University of Oulu, Oulu, Finland; Department of Human Biology, University of Cape Coast, Cape Coast, Ghana; Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana. Electronic address: adeladza.amegah@oulu.fi.
authors: Adeladza Kofi
authors: AK
authors: Amegah
authors: Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland; Public Health, Institute of Health Sciences, University of Oulu, Oulu, Finland; Respiratory Medicine Unit, Department of Medicine, Oulu University Hospital, Oulu, Finland.
authors: Jouni J K
authors: JJ
authors: Jaakkola
mesh_terms: D000328:Adult; D000397:Air Pollution / Q000009:adverse effects*; D001724:Birth Weight / Q000187:drug effects; D003430:Cross-Sectional Studies; D005260:Female; D047109:Fetal Development / Q000187:drug effects*; D006801:Humans; D007230:Infant, Low Birth Weight; D018811:Maternal Exposure / Q000009:adverse effects*; D016273:Occupational Exposure / Q000009:adverse effects*; D009790:Occupations; D011247:Pregnancy; D011256:Pregnancy Outcome; D012307:Risk Factors; D001335:Vehicle Emissions; D055815:Young Adult
chemical_list: D001335:Vehicle Emissions
keywords: Birth weight; Outdoor air pollution; Pregnancy outcomes; Preterm birth; Street vending; Traffic-related exposures