Advanced Exposure Assessment of Air Pollution and its Effects on Maternal and Child Health in Low-income Settings Open Access

Liao, Jiawen (Spring 2020)

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In this dissertation, the author explored advancing exposure assessment methods of air pollution and analyzed the maternal and child health effects of air pollution exposure from solid fuel combustion and ambient environment in low-income settings in Guatemala and India. Household air pollution from solid fuel combustion is a leading health risk factor for disease in low-income settings. Using data from the Household Air Pollution Intervention Network (HAPIN) trial in Guatemala, the author showed the feasibility of indirectly assessing household air pollution exposure in children by personal use of Bluetooth signal emitters for microenvironment classification. Based on a prospective cohort of pregnant women from HAPIN trial in Guatemala, the author then investigated the effects of gestational blood pressure effects of fine particulate matter (PM2.5) exposure. In additional to household air pollution, there are growing risks of ambient air pollution in low- and middle-income countries such as China and India, due to rapid industrialization and urbanization. The author developed a monthly ambient PM2.5 exposure prediction model using a machine-learning algorithm, based on satellite remote sensing, meteorology and land use information, cross-validated with ground-based PM2.5 monitoring stations over 10-year period in India. Ultimately, the author examined the adverse effects of ambient PM2.5 exposure on child all-cause mortality under age of five in India, linking predicted ambient air pollution and a retrospective birth cohort.

Table of Contents

Chapter 1 Introduction 1

1.1 Motivation 1

1.2 Dissertation Aims 4

Chapter 2 Background 7

2.1 Air Pollution and Maternal and Child Health 7

2.1.1 Household Air Pollution and Gestational Blood Pressure 8

2.1.2 Ambient Air Pollution Effects on Child Mortality 14

2.2 Household Air Pollution Exposure Assessment 15

2.3 Ambient Air Pollution Exposure Assessment 17

Chapter 3 Indirect Personal Household Air Pollution Exposure Assessment Using Bluetooth Low Energy Beacon Systems 20

3.1 Introduction 20

3.2 Method 21

3.2.1 Purpose and design 21

3.2.2 Study sites and populations 22

3.2.3 PM2.5 Measurements 22

3.2.4 Microenvironment Indirect PM2.5 Exposure Measurement Methods 24

3.2.5 Statistical Methods 27

3.3 Results 27

3.4 Discussion 33

3.5 Conclusion 37

Appendix for Chapter 3 38

Appendix Figures and Tables 38

Bias Estimate for Beacon Indirect Assessment Methods 43

Chapter 4 Associations of Fine Particulate Matter (PM2.5) Exposure with Gestational Blood Pressure among Rural Guatemala Women: A Prospective Cohort Study 46

4.1 Introduction 46

4.2 Method 48

4.2.1 Study site and population 48

4.2.2 Outcome and Covariates 49

4.2.3 PM2.5 Exposure 50

4.2.4 Statistical Analysis 50

4.3 Results 52

4.4 Discussion 61

4.5 Conclusion 64

Appendix for Chapter 4 65

Chapter 5 Gestational and Childhood Exposures to Ambient Fine Particulate matter and Child Survival in India: A Retrospective Cohort Study 68

5.1 Introduction 68

5.2 Methods 69

5.2.1 Study Design and Population 69

5.2.2 Ambient PM2.5 Air Pollution Exposure 71

5.2.3 Statistical Analysis 72

5.3 Results 73

5.4 Discussion 80

5.5 Conclusion 83

Appendix for Chapter 5 84

Chapter 6 Summary, Implications and Further Research 117

6.1 Summary 117

6.2 Implications 118

6.3 Further Research 119

6.4 Reflections 120

Reference 123

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