Inequalities in environmental, health, and social determinants of acute lower respiratory infections among children under five across Sub-Saharan Africa: A Scoping Summary of the Literature Open Access

Abstract

On a global scale, approximately 3 billion people rely on solid fuels for cooking and heating purposes, mostly within low and middle-income countries (LMIC) [1]. The use of these fuels result in household air pollution (HAP), which is a key environmental risk factor for many adverse health outcomes. According to the Global Burden of Disease Study, HAP is responsible for approximately 2.2-3.6 million deaths annually on a global scale and these deaths occur most commonly in the form of stroke, pneumonia, ischemic heart disease, lung cancer, and chronic obstructive pulmonary disease [2]. Children are of particular concern because in 2016, HAP (through the use of solid fuels and kerosene) contributed to almost 4 million premature deaths, with approximately half of a million of those deaths being amongst children who are less than 5 years old. Children’s exposure to HAP increases their risk of developing acute lower respiratory infections (ALRI) [3, 4]. ALRI includes a group of diseases that impact the lower respiratory tract and they also happen to be the primary cause of morbidity and mortality amongst children who are under five [5].

Several studies have shown that cleaner cook stoves can produce less HAP, thus having a positive impact on human health. Unfortunately, access to cleaner cook stove technology is not universal and it is possible that various social determinants of health (SDH) may help to better understand this inequality in cooking sources. Evidence reveals health disparities exist both between and within countries [6]. It is imperative to understand which factors play the largest role in creating these differences, which then can lead to effective policy change that can tackle these issues. With respect to sub-Saharan Africa (SSA), poverty is the most obvious factor that may have a great influence on health differences. However, there is reason to believe each country has their own set of SDH that drive adverse health conditions. In SSA, some of these may include cultural practices (i.e. female genital mutilation, women and children food taboos, and traditional medicine), brain drain, unfavorable trade agreements, uneven distribution of knowledge regarding technological innovation, and globalization [6]

Table of Contents

1.    HAP: Definition and Sources……………………………………………………………………... 1

2.    Respiratory Function……………………………………………………………………………… 2

3.    Health impacts & Disease Burden Related to HAP………………………………………………. 3

4.    Children’s Vulnerability to HAP           …………………………………………………………………. 6

5.    Social Determinants of Health……………………………………………………………………. 6

6.    Disparity within LMICs…………………………………………………………………………... 7

7.    Recommendations for future research……………………………………………………………. 8

Study location……………………………………………………………………………. 8

Data…............................................................................................................................... 10

Future Research Direction……………………………………………………………… 11

Public Health Impact………………………………………………………………....…. 12

8.    Bibliography…………………………………………………………………………………….. 14

 

List of Tables

Table 1. Related SDGs and Corresponding Targets………………………………………………………. 5

Table 2. Household air pollution statistics for the Sub Saharan African countries

to be included in this analysis…………………………………………………………………….. 8

 

 

List of Figures

Figure 1: Schematic illustrating how detrimental pollutants can be to the

respiratory system………………………………………………………………………………… 3

Figure 2: Death rate per 100,000 population from ALRI due to household air

pollution in children under 5 years, 2016           ………………………………………………………… 3

About this Master's Thesis

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School	Laney Graduate School
Department	Environmental Health
Degree	M.S.
Submission	Master's Thesis
Language	English
Research Field	Environmental Health
Keyword	social determinants of health household air pollution ALRI
Committee Chair / Thesis Advisor	Melissa Smarr, Emory University
Committee Members	Noah Scovronick, Emory University Thomas Clasen, Emory University

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