Department of Urban and Regional Planning, University of Colorado Denver, Denver, CO, USA.
CU Population Center, University of Colorado Boulder, Boulder, CO, USA.
Environ Health. 2022 Dec 12;21(1):128. doi: 10.1186/s12940-022-00943-y.
Undernutrition is a global public health crisis, causing nearly half of deaths for children under age 5 years. Little is known regarding the impact of air pollution in-utero and early childhood on health outcomes related to undernutrition. The aim of our study is to evaluate the association of prenatal and early-life exposure to PM and child malnutrition as captured by the height-for-age z-score (HAZ), and stunting in 32 countries in Africa. We also evaluated critical windows of susceptibility during pregnancy to each environmental risk.
We linked nationally representative anthropometric data from 58 Demographic and Health Surveys (DHS) (n = 264,207 children < 5 years of age) with the average in-utero PM concentrations derived from satellite imagery. We then estimated associations between PM and stunting and HAZ after controlling for child, mother and household factors, and trends in time and seasonality.
We observed lower HAZ and increased stunting with higher in-utero PM exposure, with statistically significant associations observed for stunting (OR: 1.016 (95% CI: 1.002, 1.030), for a 10 μg/m increase). The associations observed were robust to various model specifications. Wald tests revealed that sex, wealth quintile and urban/rural were not significant effect modifiers of these associations. When evaluating associations between trimester-specific PM levels, we observed that associations between PM and stunting was the largest.
This is one of the first studies for the African continent to investigate in-utero and early-life exposure to PM is an important marker of childhood undernutrition. Our results highlight that PM concentrations need to be urgently mitigated to help address undernutrition in children on the continent.
营养不良是全球公共卫生危机，导致近半数 5 岁以下儿童死亡。人们对于宫内和儿童早期接触空气污染对与营养不良相关的健康结果的影响知之甚少。我们的研究旨在评估产前和生命早期接触 PM 与身高年龄 z 分数（HAZ）和 32 个非洲国家儿童发育迟缓的关系。我们还评估了怀孕期间每个环境风险的易感性关键窗口。
我们将来自 58 项人口与健康调查（DHS）（n = 264207 名 < 5 岁儿童）的全国代表性人体测量数据与卫星图像得出的宫内 PM 浓度平均值联系起来。然后，我们在控制儿童、母亲和家庭因素以及时间和季节性趋势的情况下，估计了 PM 与发育迟缓之间的关系以及 HAZ。
我们观察到宫内 PM 暴露量较高与 HAZ 较低和发育迟缓增加有关，发育迟缓的相关性具有统计学意义（OR：1.016（95%CI：1.002，1.030），每增加 10μg/m）。观察到的关联在各种模型规格下都是稳健的。沃尔德检验表明，性别、财富五分位数和城乡不是这些关联的显著效应修饰符。当评估特定孕期 PM 水平之间的关联时，我们观察到 PM 与发育迟缓之间的关联最大。
这是非洲大陆第一项研究宫内和生命早期接触 PM 是儿童营养不良的一个重要标志物的研究之一。我们的结果强调需要紧急减轻 PM 浓度，以帮助解决非洲大陆儿童的营养不良问题。
