title: Home environment and indoor air pollution exposure in an African birth cohort study.
abstract: BACKGROUND
  Household indoor air pollution (IAP) is a global health problem and a risk factor for childhood respiratory disease; the leading cause of mortality in African children. This study aimed to describe the home environment and measure IAP in the Drakenstein Child Health Study (DCHS), an African birth cohort.
  
  
  METHODS
  An antenatal home visit to assess the home environment and measure IAP (particulate matter, sulphur dioxide, nitrogen dioxide, carbon monoxide and volatile organic compounds (VOCs)) was done on pregnant women enrolled to the DCHS, in a low-socioeconomic, peri-urban South African community. Urine cotinine measured maternal tobacco smoking and exposure. Dwellings were categorised according to 6 household dimensions. Univariate and multivariate analysis explored associations between home environment, seasons and IAP levels measured.
  
  
  RESULTS
  633 home visits were completed, with IAP measured in 90% of homes. Almost a third of participants were of the lowest socio-economic status and the majority of homes (65%) lacked 2 or more of the dwelling category dimensions. Most households had electricity (92%), however, fossil fuels were still used for cooking (19%) and heating (15%) in homes. Antenatal maternal smoking prevalence was 31%; 44% had passive smoke exposure. Of IAP measured, benzene (VOC) was significantly above ambient standards with median 5.6 μg/m3 (IQR 2.6-17.1). There were significant associations between the use of fossil fuels for cooking and increased benzene [OR 3.4 (95% CI 2.1-5.4)], carbon monoxide [OR 2.9 (95% CI 1.7-5.0)] and nitrogen dioxide [OR 18.6 (95% CI 3.9-88.9)] levels. A significant seasonal association was found with higher IAP levels in winter.
  
  
  CONCLUSIONS
  In this low-socioeconomic African community, multiple environmental factors and pollutants, with the potential to affect child health, were identified. Measurement of IAP in a resource-limited setting is feasible. Recognising and quantifying these risk factors is important in effecting public health policy changes.
authors.affiliation: Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child & Adolescent Health, University of Cape Town, Klipfontein Road, Rondebosch 7700, South Africa. Electronic address: Aneesa.vanker@uct.ac.za.
authors.forename: Aneesa
authors.initials: A
authors.lastname: Vanker
authors.affiliation: Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child & Adolescent Health, University of Cape Town, Klipfontein Road, Rondebosch 7700, South Africa. Electronic address: Barnett.whitney@gmail.com.
authors.forename: Whitney
authors.initials: W
authors.lastname: Barnett
authors.affiliation: Centre for Infectious Disease Epidemiology and Research, Room 5.48, Level 5, Falmouth building, UCT Medical School, University of Cape Town, 7700, South Africa. Electronic address: pm.nduru@uct.ac.za.
authors.forename: Polite M
authors.initials: PM
authors.lastname: Nduru
authors.affiliation: Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Stellenbosch University, Francie van Zijl Avenue, Tygerberg 7505, South Africa. Electronic address: rpg1@sun.ac.za.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Gie
authors.affiliation: Queensland Children's Medical Research Institute, and Children's Health and Environment Program, The University of Queensland, Level 4, Foundation Building, Royal Children's Hospital, Herston, Brisbane, Queensland 4029, Australia. Electronic address: p.sly@uq.edu.au.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Sly
authors.affiliation: Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child & Adolescent Health, University of Cape Town, Klipfontein Road, Rondebosch 7700, South Africa. Electronic address: heather.zar@uct.ac.za.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Zar
mesh_terms: D000328:Adult; D000393:Air Pollutants / Q000032:analysis; D016902:Air Pollution, Indoor / Q000032:analysis* / Q000706:statistics & numerical data; D002248:Carbon Monoxide / Q000032:analysis; D015331:Cohort Studies; D004784:Environmental Monitoring; D005260:Female; D006801:Humans; D018811:Maternal Exposure / Q000706:statistics & numerical data*; D009585:Nitrogen Dioxide / Q000032:analysis; D052638:Particulate Matter / Q000032:analysis; D011247:Pregnancy; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D013019:South Africa; D014028:Tobacco Smoke Pollution / Q000032:analysis; D055549:Volatile Organic Compounds / Q000032:analysis
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter; D014028:Tobacco Smoke Pollution; D055549:Volatile Organic Compounds; D002248:Carbon Monoxide; D009585:Nitrogen Dioxide
keywords: African birth cohort; Environmental health; Indoor air pollution; Maternal and child health; Public health