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Erin L. Murray
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Environmental risk factors for respiratory infections in urban Bangladeshi childrenErin L. Murray
Acute respiratory infections (ARI) cause a substantial amount of morbidity and mortality among children and are the leading cause of death worldwide in children <5 years of age. A variety of environmental factors may be contributing to a child's risk of ARI and the more severe subset of acute lower respiratory infections (ALRI). This dissertation focused on the impact of sources of indoor air pollution, factors that affect the amount of indoor air pollution a child receives, crowding, and rainfall on a child's risk of ARI and ALRI. The first two study questions utilized a longitudinal cohort study with active community-based surveillance for ARI and ALRI to assess if indicators of particulate indoor air pollution, including both sources of and factors affecting the amount of exposure, were associated with an increased risk of ARI and ALRI. The results of these analyses indicated that factors affecting the amount of exposure a child receives to indoor air pollution are clearly associated with both ARI and ALRI. Such factors include the location of the stove, ventilation within the household, and whether or not the family owns a working electric fan. Sources of indoor air pollution, such as primary cooking fuel, were not found to be associated with a child's risk of ARI or ALRI. These findings highlight the importance of air circulation and exchange in decreasing the concentrations of indoor air pollutants and respiratory pathogens within the home. The third study question focused on the relationship of rainfall and ARI and how living in crowded household conditions might impact this relationship. A case-crossover analysis, stratified on the level of crowding in the household, defined as the number of people per room, was performed to address this question. Among all children, adjusted results indicated an association between rainfall and ARI, with the odds of rainfall on the days preceding the child's onset of ARI being higher than the odds of rainfall preceding control days. The results of the stratified analysis suggested that there was effect modification by household crowding. An association was found between rainfall and ARI for children living in households with 3 or more people per room and not among children living in households with <3 people per room; however, the confidence intervals were large. This study examined more sources of indoor air pollution and factors potentially affecting the amount of indoor pollution a child receives than have previous studies. The identification of stove location and electric fan ownership as important associations suggests alternative avenues for preventing ARI and ALRI that are less expensive and potentially easier to implement than current prevention strategies like providing alternate fuel sources or improved stoves with chimneys. This appears to be the first study to assess the association between rainfall and ARI and how household crowding impacts this relationship. These findings contribute to the understanding of the seasonality of respiratory infections in tropical climates. All of these findings can inform policy and practices to reduce ARI and ALRI in children in developing countries, like Bangladesh, where the burden is greatest.
Health and environmental sciences; Respiratory infections; Bangladesh; Indoor air pollution; Rainfall; Public health; Epidemiology; 0573:Public health; 0766:Epidemiology
J. E. McGowan, Jr.
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