Abstract
Globally, it was estimated that maternal and under-five deaths were high in low-income countries than that of high-income countries. Most studies, however, have focused only on the clinical causes of maternal and under-five deaths, and yet there could be other factors such as ambient particulate matter (PM). The current global estimates indicate that exposure to ambient PM2.5 (with ≤ 2.5 microns aerodynamic diameter) has caused about 7 million deaths and over 100 million disability-adjusted life-years. There are also several health risks that have been linked PM2.5, including mortality, both regionally and globally; however, PM2.5 is a mixture of many compounds from various sources. Globally, there is little evidence of the health effects of various types of PM2.5, which may uniquely contribute to the global burden of disease. Currently, only two studies had estimated the effects of discriminated ambient PM2.5, that is, anthropogenic, biomass and dust, on under-five and maternal mortality using satellite measurements, and this study found a positive association in Africa and Asia. However, the study area was conducted in only one region and may not reflect the spatial variations throughout the world. Therefore, in this study, we discriminated different ambient PM2.5 and estimated the effects on a global scale. Using the generalized linear mixed-effects model (GLMM) with a random-effects model, we found that biomass PM2.5 was associated with an 8.9% (95% confidence interval [CI] 4.1–13.9%) increased risk of under-five deaths, while dust PM2.5 was marginally associated with 9.5% of under-five deaths. Nevertheless, our study found no association between PM2.5 type and global maternal deaths. This result may be because the majority of maternal deaths could be associated with preventable deaths that would require clinical interventions. Identification of the mortality-related types of ambient PM2.5 can enable the development of a focused intervention strategy of placing appropriate preventive measures for reducing the generation of source-specific PM2.5 and subsequently diminishing PM2.5-related mortality.
Highlights
It was estimated that maternal and under-five deaths were high in low-income countries than that of high-income countries
These high maternal death rates in low- and middle-income countries (LMICs) was reflected in the deaths of the under-five children, which is estimated to be high in some regions like the Sub-Saharan Africa (SSA, 76 deaths per 1000 live births) as compared to that of other regions like the European region (9 deaths per 1000 live births) in 2 0182
Studies have indicated that sources of P M2.5 may vary and are likely to contribute to the accumulation of various toxic compounds that are suspended in the air, such as sulphur oxides ( SOx), carbon monoxide (CO), particulates, and nitrogen oxides ( NOx)[8,9,10], which may contribute to various health problems and subsequently an increase in the global burden of disease
Summary
It was estimated that maternal and under-five deaths were high in low-income countries than that of high-income countries. There are limited studies that have estimated the effects of discriminated or categorized ambient PM2.5, that is, anthropogenic, biomass and dust, on under-five and maternal mortality using satellite measurements, and these studies found a positive association in Africa[5] and Asia[7]. These studies[5,7] were regional and may not reflect the spatial variations throughout the world. Several authors developed a modest method for identifying and quantifying different ambient PM2.5 types that are suspended in the air[13], and this method has been applied to study the types of ambient P M2.5 and mortality in A frica[4]
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