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European Journal of Applied Sciences – Vol. 10, No. 2

Publication Date: April 25, 2022

DOI:10.14738/aivp.102.10791. Mulenga, D., & Zulu, M. (2022). Particulate Air Pollution and Impaired Maternal Lung Function in Ndola and Masaiti of Copperbelt

Province in Zambia. European Journal of Applied Sciences, 10(2). 455-467.

Services for Science and Education – United Kingdom

Particulate Air Pollution and Impaired Maternal Lung Function in

Ndola and Masaiti of Copperbelt Province in Zambia

David Mulenga (MPH)

Department of Public Health, Michael Chilufya Sata School of Medicine

Copperbelt University Public Health Unit, Ndola

Mbawe Zulu (MScHA)

Department of Basic Sciences, Michael Chilufya Sata School of Medicine

Copperbelt University Public Health Unit, Ndola

ABSTRACT

Background: Evidence of association between maternal indoor air pollution (IAP)

exposure and impaired lung function (LF) in sub-Saharan Africa (SSA) is

insufficient. We assessed association between maternal IAP and impaired LF in

Masaiti and Ndola. Method: The study used questionnaire to collect data (N =1170)

and IAP exposure defined as use of biomass fuel indoors and elevated PM2.5 using

foobot (China) and LFs using a spirometer (Spirobank G, Italy). Data were analysed

using SPSS version 20. Results: Results indicated an association between fuel use

and lung function result. The median (Q1, Q3) PM2.5 before, during and after cooking

showed a significant difference (p value <0.001). The median (Q1, Q2) PM2.5 during

cooking and daily average were 501(411, 686) μg/m3 and 393 (303,578) μg/m3.

Association between PM2.5 and fuel type (p value = 0.005) but no association

between PM2.5 and kitchen type (p value = 0.124). Association between fuel type and

impaired lung function. Compared with combined fuel types (Charcoal and

electricity), crop residue only, gave 2times more likely to have a declined lung

function [AOR: 2.33 (1.27 – 4.30] and electricity only, 57% less likely to have

declined lung function [AOR: 0.43, 95% CI (0.26 – 0.69)]. Conclusion: Maternal IAP

exposure maybe associated with elevated risk of impaired LFs. More research using

longitunal studies carefully designed for low income countries is needed. Public

awareness of the effects of IAP due to biomass fuels and interventions to reduce the

use of biomass fuels are required.

Keyword: Indoor Air Pollution, Lung function test, Particulate Matter, Biomass fuel

INTRODUCTION

According to the Health and Environment Linkages Initiative (HELI), in many of the low income

countries, one of the most common gradual causes of death is indoor air pollution (IAP) [1].

This is mainly generated from inefficient and poorly ventilated stoves burning biomass fuels

such as wood, crop waste, dung or coal [2]. The World Health Organisation estimates that over

half of the global population (52%) cook and heat with solid fuels including biomass fuels and

coal [3] and it has further estimated that more than 2.4 billion people, generally among the

world’s poorest, rely directly upon biomass fuels for their heating and cooking. WHO has

further ranked IAP as the fourth most important risk factor that contribute to disease and death

in developing countries where mortality rates are generally high [4]. The Institute for Health

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European Journal of Applied Sciences (EJAS) Vol. 10, Issue 2, April-2022

Services for Science and Education – United Kingdom

Metrics and Evaluation (IHME) also estimates that IAP is responsible for 1.6 million deaths each

year while WHO puts it at 4.3 million. IHME considers IAP from biomass fuels as a leading risk

factor for premature death.

The World energy Outlook indicates that biomass emissions contain thousands of health

damaging substances and of these, there are small particles of less than 10 microns in diameter

(PM10) which are among the most dangerous substances. Such pollutants penetrate deep into

the lungs and are responsible for acute lower respiratory disease, chronic obstructive

pulmonary disease, cancers and other illnesses. IAP is among the key human challenges in

modern society because people spend approximately 90% of their time indoors, especially at

their own homes [5]. As a result, it is estimated that three billion people worldwide are exposed

daily to aerocontaminants of IAP due to the use of solid fuels such as biomass or coal for

combustion. Such use leads to release of products of incomplete combustion, particulate matter

2.5 (PM2.5). This exposure has been studied and shown to contribute to the deterioration of lung

function [6;7;8]

Indoor PM2.5 affects lung function development, aggravates asthma, and causes other

respiratory symptoms [9] and women are disproportionately affected because they spend

more time indoors and are involved in cooking. Therefore, the correlation between indoor

particulate pollution and impaired maternal lung functions prompts interest.

METHODS AND MATERIALS

Study design and population

Pregnant mothers in Masaiti and Ndola distrit of the Copperbelt province of Zambia were

sampled from 2016 to 2017. The study population was obtained from the health facilities based

in Masaiti and Ndola and recruitment for household air quality monitoring was based on the

willingness to be included in the study. All the pregnant mothers living in the households were

asked whether they would agree to participate in the study, and those that agreed were

included. A total of 1170 pregnant mothers from Ndola (N=689) and Masaiti (N=481). The

inclusion criteria for eligible pregnant mothers were as follows: age > 18, residence > 2 years

in Masaiti or Ndola, registered/attends antenat services at the health facilities which are the

study sites for our study in Masaiti and Ndola. Exclusion criterion was history of tuberculosis,

asthma with concomitant diagnoses of chronic obstructive pulmonary disease (chronic

bronchitis or emphysema). A flowchart is presented in figure 1.

Sampling methods

Sample size

To determine the sample size of the study, we considered multistage cluster sampling design.

Ultimately, the total sample size was estimated at 1170.

Research tools

The cross-sectional epidemiological study included the questionnaire, spirometric

examination, and monitoring of particulate matter (PM2.5) pollution.

IAP Monitoring

The PM2.5 concentrations inside (kitchen) were measured using a real-time digital indoor air

pollution monitoring (Foobot, China) while cooking and outside the cooking times. Three

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Mulenga, D., & Zulu, M. (2022). Particulate Air Pollution and Impaired Maternal Lung Function in Ndola and Masaiti of Copperbelt Province in

Zambia. European Journal of Applied Sciences, 10(2). 455-467.

URL: http://dx.doi.org/10.14738/aivp.102.10791

measurements were utilised to calculate the average relative PM2.5, concentration. Monitoring

was consistently applied across all households in Masaiti and Ndola.

Spirometry

Data on lung functions including forced expiratory volume in 1s (FEV1), forced vital capacity

(FVC) and the FEV1/FVC ration were determined using a portable electronic Spirobank. A

demonstration was conducted before pregnant mothers were asked to inhale completely and

then exhale forcefully after the meter was put in their mouth and until the lips were sealed

around the mouthpiece. The maneuver was only accepted when both FEV1 and FVC were within

0.20L. of the best-effort FVC and FEV11, back-extrapolated volumes were low (<0.5% of the FVC

and 0.15L), and the final accumulated volume was low in accordance with the practice guideline

of the American Thoracic Society. The standard expiratory maneuvers for each pregnant

mother were set a three.

Fig. 1

Reseach flowchart