World Health Organization Interim Research Articles

Disability Adjusted Life Years (DALYs) in Terms of Years of Life Lost (YLL) Due to Premature Adult Mortalities and Postneonatal Infant Mortalities Attributed to PM2.5 and PM10 Exposures in Kuwait.

Ambient air pollution in terms of fine and coarse particulate matter (PM2.5 and PM10) has been shown to increase adult and infant mortalities. Most studies have estimated the risk of mortalities through attributable proportions and number of excess cases with no reference to the time lost due to premature mortalities. Disability adjusted life years (DALYs) are necessary to measure the health impact of Ambient particulate matter (PM) over time. In this study, we used life-tables for three years (2014–2016) to estimate the years of life lost (YLL), a main component of DALYs, for adult mortalities (age 30+ years) and postneonatal infant mortalities (age 28+ days–1 year) associated with PM2.5 exposure and PM10 exposure, respectively. The annual average of PM2.5 and PM10 concentrations were recorded as 87.9 μg/m3 and 167.5 μg/m3, which are 8 times greater than the World Health Organization (WHO) air quality guidelines of 10 μg/m3 and 20 μg/m3, respectively. Results indicated a total of 252.18 (95% CI: 170.69–322.92) YLL for all ages with an increase of 27,474.61 (95% CI: 18,483.02–35,370.58) YLL over 10 years. The expected life remaining (ELR) calculations showed that 30- and 65-year-old persons would gain 2.34 years and 1.93 years, respectively if the current PM2.5 exposure levels were reduced to the WHO interim targets (IT-1 = 35 μg/m3). Newborns and 1-year old children may live 79.81 and 78.94 years, respectively with an increase in average life expectancy of 2.65 years if the WHO PM10 interim targets were met (IT-1 = 70 μg/m3). Sensitivity analyses for YLL were carried out for the years 2015, 2025, and 2045 and showed that the years of life would increase significantly for age groups between 30 and 85. Life expectancy, especially for the elderly (≥60 years), would increase at higher rates if PM2.5 levels were reduced further. This study can be helpful for the assessment of poor air quality represented by PM2.5 and PM10 exposures in causing premature adult mortalities and postneonatal infant mortalities in developing countries with high ambient air pollution. Information in this article adds insights to the sustainable development goals (SDG 3.9.1 and 11.6.2) related to the reduction of mortality rates attributed to ambient air levels of coarse and fine particulate matter.

Modeling the potential health benefits of lower household air pollution after a hypothetical liquified petroleum gas (LPG) cookstove intervention

Introduction: Improved biomass and advanced fuel cookstoves can lower household air pollution (HAP), but levels of fine particulate matter (PM2.5) often remain above the World Health Organization (WHO) recommended interim target of 35μg/m3.Methods: Based on existing literature, we first estimate a range of likely levels of personal PM2.5 before and after a liquefied petroleum gas (LPG) intervention. Using simulations reflecting uncertainty in both the exposure estimates and exposure-response coefficients, we estimate corresponding expected health benefits for systolic blood pressure (SBP) in adults, birthweight, and pneumonia incidence among children <2years old. We also estimate potential avoided premature mortality among those exposed.Results: Our best estimate is that an LPG stove intervention would decrease personal PM2.5 exposure from approximately 270μg/m3 to approximately 70μg/m3, due to likely continued use of traditional open-fire stoves. We estimate that this decrease would lead to a 5.5mmHg lower SBP among women over age 50, a 338g higher birthweight, and a 37% lower incidence of severe childhood pneumonia. We estimate that decreased SBP, if sustained, would result in a 5%–10% decrease in mortality for women over age 50. We estimate that higher birthweight would reduce infant mortality by 4 to 11 deaths per 1000 births; for comparison, the current global infant mortality rate is 32/1000 live births. Reduced exposure is estimated to prevent approximately 29 cases of severe pneumonia per year per 1000 children under 2, avoiding approximately 2–3 deaths/1000 per year. However, there are large uncertainties around all these estimates due to uncertainty in both exposure estimates and in exposure-response coefficients; all health effect estimates include the null value of no benefit.Conclusions: An LPG stove intervention, while not likely to lower exposure to the WHO interim target level, is still likely to offer important health benefits.

Health burden attributable to ambient PM2.5 in China

In China, over 1.3 billion people have high health risks associated with exposure to ambient fine particulate matter (PM2.5) that exceeds the World Health Organization (WHO) Air Quality Guidelines (AQG). The PM2.5 mass concentrations from 1382 national air quality monitoring stations in 367 cities, between January 2014 and December 2016, were analyzed to estimate the health burden attributable to ambient PM2.5 across China. The integrated exposure-response model was applied to estimate the relative risks of disease-specific mortality. Disease-specific mortality baselines in province-level administrative units were adjusted by the national mortality baseline to better reveal the spatial inequality of the health burden associated with PM2.5. Our study suggested that PM2.5 in 2015 contributed as much as 40.3% to total stroke deaths, 33.1% to acute lower respiratory infection (ALRI, <5yr) deaths, 26.8% to ischemic heart disease (IHD) deaths, 23.9% to lung cancer (LC) deaths, 18.7% to chronic obstructive pulmonary disease (COPD) deaths, 30.2% to total deaths combining IHD, stroke, COPD, and LC, 15.5% to all cause deaths. The population weighted average (PWA) attributable mortality rates (10−5 y−1) were 112.0 in current year analysis, and 124.3 in 10-year time lag analysis. The Mortality attributable to PM2.5 in 10-year time lag analysis (1.7 million) was 12% higher than the current year analysis (1.5 million). Our study also estimated site-specific annual PM2.5 concentrations in scenarios of achieving WHO interim targets (ITs) and AQG. The mortality benefits will be 24.0%, 44.8%, 70.8%, and 85.2% of the total current mortalities (1.5 million) when the PWA PM2.5 concentrations in China meets the WHO IT-1, IT-2, IT-3, and AQG, respectively. We expect air quality modeling and cost-benefits analysis of emission reduction scenarios and corresponding health benefits in meeting the site-specific annual PM2.5 concentrations (WHO IT-1, IT-2, IT-3, and AQG) this study raised.

New developments in the treatment of drug-resistant tuberculosis: clinical utility of bedaquiline and delamanid.

The current treatment for drug-resistant tuberculosis (TB) is long, complex, and associated with severe and life-threatening side effects and poor outcomes. For the first time in nearly 50 years, there have been two new drugs registered for use in multidrug-resistant TB (MDR-TB). Bedaquiline, a diarylquinoline, and delamanid, a nitromidoxazole, have received conditional stringent regulatory approval and have World Health Organization interim policy guidance for their use. As countries improve and scale up their diagnostic services, increasing number of patients with MDR-TB and extensively drug-resistant TB are identified. These two new drugs offer a real opportunity to improve the outcomes of these patients. This article reviews the evidence for these two new drugs and discusses the clinical questions raised as they are used outside clinical trial settings. It also reviews the importance of the accompanying drugs used with these new drugs. It is important that barriers hindering the use of these two new drugs are addressed and that the existing clinical experience in using these drugs is shared, such that their routine-use programmatic conditions is scaled up, ensuring maximum benefit for patients and countries battling the MDR-TB crisis.

Assessment of Population Exposure to Coarse and Fine Particulate Matter in the Urban Areas of Chennai, India.

Research outcomes from the epidemiological studies have found that the course (PM10) and the fine particulate matter (PM2.5) are mainly responsible for various respiratory health effects for humans. The population-weighted exposure assessment is used as a vital decision-making tool to analyze the vulnerable areas where the population is exposed to critical concentrations of pollutants. Systemic sampling was carried out at strategic locations of Chennai to estimate the various concentration levels of particulate pollution during November 2013–January 2014. The concentration of the pollutants was classified based on the World Health Organization interim target (IT) guidelines. Using geospatial information systems the pollution and the high-resolution population data were interpolated to study the extent of the pollutants at the urban scale. The results show that approximately 28% of the population resides in vulnerable locations where the coarse particulate matter exceeds the prescribed standards. Alarmingly, the results of the analysis of fine particulates show that about 94% of the inhabitants live in critical areas where the concentration of the fine particulates exceeds the IT guidelines. Results based on human exposure analysis show the vulnerability is more towards the zones which are surrounded by prominent sources of pollution.

Addressing the Burden of Disease Attributable to Air Pollution in India: The Need to Integrate across Household and Ambient Air Pollution Exposures

Addressing the Burden of Disease Attributable to Air Pollution in India: The Need to Integrate across Household and Ambient Air Pollution Exposures

Assessment of the Health Impacts and Economic Burden Arising from Proposed New Air Quality Objectives in a High Pollution Environment

We conducted a health impact assessment of the government's proposed new air quality objectives (AQO) in Hong Kong, a high pollution environment. We based this on the World Health Organization (WHO) 2005 Air Quality Guidelines (AQG) and used a lognormal probability density function to model possible changes in annual mean pollutant levels resulting from the new AQO. All of the proposed short-term AQO were based on WHO interim targets (IT) or AQG, but allowed additional exceedances of these single limit values. Compliance with these short-term AQO may reduce (18-30%) the current annual mean concentrations but the distribution proportions exceeding the annual or annualized AQG remain high (83-100%). For SO2, the proposed 24-hr AQO of 125 μg m -3 , with 3 days exceedances, cannot ensure reduction of the current annual mean but may legally permit an increase of the pollutant concentration distribution. If the proposed legal limits of AQO are fully exploited by polluters, we estimated the annual number of avoidable deaths at 1860, and avoidable health care events at 5.2 million doctor visits and 92745 hospital bed-days with a total annual community cost of US$2.6 billion. The proposed AQO may only reduce the current air pollution health impacts by 17% but could achieve 41% reduction if additional exceedances were not permitted. An epidemiologic approach should be adopted to assess external costs arising from modifications of WHOAQG and support accountability in air quality management. This analysis of the WHOAQG in a high pollution setting demonstrates problems arising from the absence of annual limits for some pollutants and the discordance between the short-term and annual AQG, suggesting that revisions based on a lognormal probability model should be considered.

Indoor air quality impacts of an improved wood stove in Ghana and an ethanol stove in Ethiopia

This study was undertaken to assess the potential of two types of improved cookstoves to reduce indoor air pollution in African homes. An ethanol stove, the CleanCook, was tested in three locations in Ethiopia: the city of Addis Ababa and the Bonga and Kebribeyah Refugee Camps, while a wood-burning rocket stove, the Gyapa, was evaluated in Accra, Ghana. In both countries, kitchen concentrations of PM 2.5 and CO, the two pollutants responsible for the bulk of the ill-health associated with indoor smoke, were monitored in a before and after study design without controls. Baseline (‘before’) measurements were made in households using a traditional stove or open fire. ‘After’ measurements were performed in the same households, once the improved stove had been introduced. PM 2.5 was measured using UCB Particle Monitors, which have photoelectric detectors. CO was measured with Onset HOBO Loggers. In Ghana and Kebribeyah Camp, CO was also measured with Gastec diffusion tubes. In Ghana, average 24-hour PM 2.5 concentrations decreased 52% from 650 μg/m 3 in the 'before' phase to 320 μg/m 3 in the 'after' phase ( p = 0.00), and average 24-hour kitchen CO concentrations decreased 40% from 12.3 ppm to 7.4 ppm ( p = 0.01). Including all three subgroups in Ethiopia, average PM 2.5 concentrations decreased 84% from 1 250 μg/m 3 to 200 μg/m 3 ( p = 0.00) and average CO concentrations decreased 76% from 38.9 ppm to 9.2 ppm ( p = 0.00). 24-hour average CO levels in households using both the Gyapa and CleanCook stoves met, or nearly met, the World Health Organization (WHO) 8-hour Air Quality Guideline. PM 2.5 concentrations were well above both the WHO 24-hour Guideline and Interim Targets. Therefore, despite the significant improvements associated with both of these stoves, further changes in stove or fuel type or household fuel mixing patterns would be required to bring PM to levels that are not considered harmful to health.

The World Health Organization Interim Commission

The World Health Organization Interim Commission