Dr. Archana Patel, MD, DNB (Pediatrics), MSCE, PhD , Chief ...
Transcript of Dr. Archana Patel, MD, DNB (Pediatrics), MSCE, PhD , Chief ...
Lata Medical Research Foundation LMRF
Dr. Archana Patel, MD, DNB (Pediatrics), MSCE, PhD ,
Chief Functionary Officer (CFO) and Vice President, Lata Medical Research Foundation,
Ex- Professor of Pediatrics Indira Gandhi Government Medical College
Nagpur – 440018, India
Lata Medical Research Foundation LMRF
Impact of Exposure to Household Air Pollution (HAP)on Stillbirths, Perinatal,
Very Early and Late Neonatal Mortality- a multicenter prospective cohort study
in rural communities in India, Pakistan, Kenya, Zambia and Guatemala
Archana Patel, Patricia Hibberd, NICHD’s Global Network Group.
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Lata Medical Research Foundation LMRF Background
In a large multi-country observational study, we examined whether exposure to HAP was associated with perinatal mortality (stillbirths from gestation week 20and deaths through day7 of life) as well as when the deaths occurred (macerated, non-macerated stillbirths, very early neonatal mortality (day 0-2) and later neonatal mortality (day 3-28).
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Lata Medical Research Foundation LMRF Methods
The study was conducted between May 2011 and October 2012.
Questions about household fuel use were added to
pregnancy, labor and delivery and neonatal data collection
Polluting fuels included kerosene, charcoal, coal, wood,
straw, crop waste and dung. Clean fuels included electricity, liquefied petroleum gas (LPG) and natural gas.
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Lata Medical Research Foundation LMRF Methods
Global Network Sites
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Lata Medical Research Foundation LMRF Study Flow Diagram
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Enrolled N=69,705 (99.6%)
Exclusions (N=2,847 (5%))
Miscarriages: N=1102 Multiple gestation: N=919 Termination of pregnancy: N=440 Lost to follow-up: N=336 Day 7 Outcome missing: N=33 Maternal Age missing: N=10 Maternal Parity missing: N=7
Singleton Pregnancies Analyzed N=54,082 (77%)
Singleton Pregnancies Analyzed N=11,830 (93%)
Exclusions (N=946 (7%)) Miscarriages: N=422 Multiple gestation: N=216 Delivery data missing: N=113 Termination of pregnancy: N=188 Day 7 Outcome missing: N=7 Maternal Age missing: N=0 Maternal Parity missing: N=0
Households Using Polluting Fuel
N=56,929 (82%)
Household Using Clean Fuel
N=12,776 (18%)
Eligible Pregnant Women N=70,016 (100%)
Exclusions (N=311 (0.4%))
Other fuel type: N=283 Fuel type missing: N=28
Lata Medical Research Foundation LMRF Results
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Fuel Use by Global Network Site
Lata Medical Research Foundation LMRF Results
Characteristic
Perinatal Mortality (through day 7 of
life) N=3,176 n (%)
Alive on day 8 of life
N=62,736 n (%)
Relative Risk Adjusted for Global Network Site
and Community (95% CI)
Multivariate Analysis -
Adjusted Relative Risk
(95% CI)
HAP exposure 3,176 62,736
Polluting Fuel 2,683 (84) 51,399 (82) 1.36 (1.25, 1.49) 1.44 (1.30, 1.61)
Clean Fuel 493 (16) 11,337 (18) 1.00 1.00
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Table 1: Risk Factors for Perinatal Mortality
* Adjusted for Maternal age, Education, Parity, Antenatal Care, Delivery attendant, delivery location, infant gender, daily smoking in the household
Lata Medical Research Foundation LMRF
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Table 2: Risk Factors for the Multilevel Mortality Variable Characteristic
Multivariate Analysis - Adjusted Odds Ratios (95% Confidence Interval)
Macerated Stillbirths
Non-Macerated Stillbirths
Early Neonatal Mortality day 0-2 of life (NMR_0-2)
Later Neonatal Mortality Day
3-28 of life (NMR_3-28)
Alive on Day 29 (Reference
Group)
HAP exposure
Polluting Fuel 1.66 (1.23, 2.25) 1.43 (1.15, 1.85) 1.82 (1.47, 2.22) 1.28 (0.91, 1.76) 1.00
Clean Fuel 1.00 1.00 1.00 1.00 1.00
Table 2: Risk Factors for the Multilevel Mortality Variable
* Adjusted for Maternal age, Education, Parity, Antenatal Care, Delivery attendant, delivery location, infant gender, daily smoking in the household
Lata Medical Research Foundation LMRF Conclusion
Perinatal mortality was associated with
exposure to HAP from week 20 of pregnancy through at least day 2 of life. Since pregnancy losses before labor and delivery are difficult to track, the effect of exposure to polluting fuels on fetal losses may have been underestimated.
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Lata Medical Research Foundation LMRF
Does smoke from biomass fuel contribute to anemia in pregnant women in Nagpur, India? A cross-
sectional study
Charlotte M. Page, Archana Patel, Patricia L. Hibberd
Lata Medical Research Foundation LMRF Background
We hypothesized that exposure to smoke from
biomass fuel– which is widely used for household
energy needs in resource-limited settings – could
exacerbate anemia in pregnancy, possibly as a
result of systemic inflammation
Lata Medical Research Foundation LMRF Objective
To evaluate whether exposure to smoke from
biomass fuel (wood, straw, crop residues, or
dung) as opposed to clean fuel (electricity,
liquefied petroleum gas, natural gas, or biogas)
is an independent risk factor for anemia in
pregnancy, classified by severity. 14/04/15 13
Lata Medical Research Foundation LMRF Methods
A secondary analysis was performed using data collected from a rural pregnancy cohort (N=12,782) in Nagpur, India in 2011-2013 as part of the NIH-funded Maternal and Newborn Health Registry Study.
Multinomial logistic regression was used to estimate the effect of biomass
fuel vs. clean fuel use on anemia in pregnancy, controlling for § maternal age, § body mass index, § education level, § exposure to household tobacco smoke, § parity, § trimester when hemoglobin was measured, and § receipt of prenatal iron and folate supplements
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Lata Medical Research Foundation LMRF Results
Table 3. Multivariate analysis of risk factors for anemia in pregnant women in Nagpur, India, 2011-2013: multivariate, multinomial logistic regression model.
• *Baseline category • ‡ Differs significantly from 1 at the 95% confidence level • Abbreviations: RRR = relative risk ratio, 95% CI = 95% confidence interval, BMI = body mass index. • Adjusted for co-variates- Education, exposure to household tobaco smoke, Parity, Trimester, Prenatal iron and
folic acid supplementation
Mild anemia Moderate-to-severe anemia
Risk factor Category RRR 95% CI RRR 95% CI
Fuel type Clean fuel 1.00* 1.00*
Biomass fuel 1.38 1.19-1.61‡ 1.79 1.53-2.09‡
Age (years) - 0.95 0.93-0.98‡ 0.94 0.91-0.96‡
BMI (kg/m2) - 0.92 0.90-0.94‡ 0.83 0.81-0.86‡
Lata Medical Research Foundation LMRF Conclusion
In our study population, exposure to
biomass smoke was associated with higher risks of mild and moderate-to-severe anemia in pregnancy, independent of covariates.
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Lata Medical Research Foundation LMRF
THANK YOU
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