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Background: Antenatal factors and environmental exposures contribute to recurrent wheezing in early childhood., Aim: To identify antenatal and environmental factors associated with recurrent wheezing in children from birth to 48 months in the mother and child in the environment cohort, using time-to-event analysis., Method: Maternal interviews were administered during pregnancy and postnatally and children were followed up from birth to 48 months (May 2013-October 2019). Hybrid land-use regression and dispersion modelling described residential antenatal exposure to nitrogen dioxide (NO 2 ) and particulate matter of 2.5 µm diameter (PM 2.5 ). Wheezing status was assessed by a clinician. The Kaplan-Meier hazard function and Cox-proportional hazard models provided estimates of risk, adjusting for exposure to environmental tobacco smoke (ETS), maternal smoking, biomass fuel use and indoor environmental factors., Results: Among 520 mother-child pairs, 85 (16%) children, had a single wheeze episode and 57 (11%) had recurrent wheeze. Time to recurrent wheeze (42.9 months) and single wheeze (37.8 months) among children exposed to biomass cooking fuels was significantly shorter compared with children with mothers using electricity (45.9 and 38.9 months, respectively (p=0.03)). Children with mothers exposed to antenatal ETS were 3.8 times more likely to have had recurrent wheeze compared with those not exposed (adjusted HR 3.8, 95% CI 1.3 to 10.7). Mean birth month NO 2 was significantly higher among the recurrent wheeze category compared with those without wheeze. NO 2 and PM 2.5 were associated with a 2%-4% adjusted increased wheezing risk., Conclusion: Control of exposure to ETS and biomass fuels in the antenatal period is likely to delay the onset of recurrent wheeze in children from birth to 48 months., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: The aim of this review was to summarize the evidence of the exposure assessment approaches of indoor particulate matter (PM) during pregnancy and to recommend future focus areas., Content: Exposure to indoor PM during pregnancy is associated with adverse birth outcomes. However, many questions remain about the consistency of the findings and the magnitude of this effect. This may be due to the exposure assessment methods used and the challenges of characterizing exposure during pregnancy. Exposure is unlikely to remain constant over the nine-month period. Pregnant females' mobility and activities vary - for example, employment status may be random among females, but among those employed, activities are likely to be greater in the early pregnancy than closer to the delivery of the child., Summary: Forty three studies that used one of the five categories of indoor PM exposure assessment (self-reported, personal air monitoring, household air monitoring, exposure models and integrated approaches) were assessed. Our results indicate that each of these exposure assessment approaches has unique characteristics, strengths, and weaknesses. While questionnaires and interviews are based on self-report and recall, they were a major component in the reviewed exposure assessment studies. These studies predominantly used large sample sizes. Precision and detail were observed in studies that used integrated approaches (i. e. questionnaires, measurements and exposure models)., Outlook: Given the limitations presented by these studies, exposure misclassification remains possible because of personal, within and between household variability, seasonal changes, and spatiotemporal variability during pregnancy. Therefore, using integrated approaches (i. e. questionnaire, measurements and exposure models) may provide better estimates of PM levels across trimesters. This may provide precision for exposure estimates in the exposure-response relationship., (© 2020 Walter de Gruyter GmbH, Berlin/Boston.)

Air pollution can cause many adverse health outcomes, including cardiovascular and respiratory disorders. Land use regression (LUR) models are frequently used to describe small-scale spatial variation in air pollution levels based on measurements and geographical predictors. They are particularly suitable in resource limited settings and can help to inform communities, industries, and policy makers. Weekly measurements of NO₂ and PM 2.5 were performed in three informal areas of the Western Cape in the warm and cold seasons 2015⁻2016. Seasonal means were calculated using routinely monitored pollution data. Six LUR models were developed (four seasonal and two annual) using a supervised stepwise land-use-regression method. The models were validated using leave-one-out-cross-validation and tested for spatial autocorrelation. Annual measured mean NO₂ and PM 2.5 were 22.1 μg/m³ and 10.2 μg/m³, respectively. The NO₂ models for the warm season, cold season, and overall year explained 62%, 77%, and 76% of the variance (R²). The PM 2.5 annual models had lower explanatory power (R² = 0.36, 0.29, and 0.29). The best predictors for NO₂ were traffic related variables (major roads, bus routes). Local sources such as grills and waste burning sites appeared to be good predictors for PM 2.5 , together with population density. This study demonstrates that land-use-regression modelling for NO₂ can be successfully applied to informal peri-urban settlements in South Africa using similar predictor variables to those performed in Europe and North America. Explanatory power for PM 2.5 models is lower due to lower spatial variability and the possible impact of local transient sources. The study was able to provide NO₂ and PM 2.5 seasonal exposure estimates and maps for further health studies.

In low-resource settings, there is a need to develop models that can address contributions of household and outdoor sources to population exposures. The aim of the study was to model indoor PM 2.5 using household characteristics, activities, and outdoor sources. Households belonging to participants in the Mother and Child in the Environment (MACE) birth cohort, in Durban, South Africa, were randomly selected. A structured walk-through identified variables likely to generate PM 2.5 . MiniVol samplers were used to monitor PM 2.5 for a period of 24 hours, followed by a post-activity questionnaire. Factor analysis was used as a variable reduction tool. Levels of PM 2.5 in the south were higher than in the north of the city (P < .05); crowding and dwelling type, household emissions (incense, candles, cooking), and household smoking practices were factors associated with an increase in PM 2.5 levels (P < .05), while room magnitude and natural ventilation factors were associated with a decrease in the PM 2.5 levels (P < .05). A reasonably robust PM 2.5 predictive model was obtained with model R 2 of 50%. Recognizing the challenges in characterizing exposure in environmental epidemiological studies, particularly in resource-constrained settings, modeling provides an opportunity to reasonably estimate indoor pollutant levels in unmeasured homes., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Despite the toxicity and widespread use of manganese (Mn) and lead (Pb) as additives to motor fuels and for other purposes, information regarding human exposure in Africa is very limited. This study investigates the environmental exposures of Mn and Pb in Durban, South Africa, a region that has utilized both metals in gasoline. Airborne metals were sampled as PM(2.5) and PM(10) at three sites, and blood samples were obtained from a population-based sample of 408 school children attending seven schools. In PM(2.5), Mn and Pb concentrations averaged 17±27 ng m(-3) and 77±91 ng m(-3), respectively; Mn concentrations in PM(10) were higher (49±44 ng m(-3)). In blood, Mn concentrations averaged 10.1±3.4 μg L(-1) and 8% of children exceeded 15 μg L(-1), the normal range. Mn concentrations fit a lognormal distribution. Heavier and Indian children had elevated levels. Pb in blood averaged 5.3±2.1 μg dL(-1), and 3.4% of children exceeded 10 μg dL(-1), the guideline level. Pb levels were best fit by a mixed (extreme value) distribution, and boys and children living in industrialized areas of Durban had elevated levels. Although airborne Mn and Pb concentrations were correlated, blood levels were not. A trend analysis shows dramatic decreases of Pb levels in air and children's blood in South Africa, although a sizable fraction of children still exceeds guideline levels. The study's findings suggest that while vehicle exhaust may contribute to exposures of both metals, other sources currently dominate Pb exposures., (Copyright © 2010 Elsevier B.V. All rights reserved.)