Effect of a randomized controlled clean stove intervention study on inflammatory biomarkers in pregnant women in Ibadan, Nigeria
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1 Effect of a randomized controlled clean stove intervention study on inflammatory biomarkers in pregnant women in Ibadan, Nigeria Elizabeth Frank 4 th Year Biological Sciences major and History, Philosophy, and Social Studies of Science and Medicine major E Bartlett, D Alexander, A Dutta, D Adu, T Ibigbami, F Edem, G Arinola, T Karrison, CO Olopade
2 Scope of the HAP problem Over 3 Billion people cook with solid fuels and other polluting fuels 4 million premature deaths each year are attributable to household air pollution Most deaths occur in women and children Systemic inflammation is suspected as etiology for cerebrovascular diseases, pneumonia in children, diabetes and COPD
3 Study Hypothesis CleanCook stove and bioethanol fuel use will reduce pregnant women s personal exposures to PM 2.5 (particulate matter), PAH (polycyclic aromatic hydrocarbon), and CO and reduce adverse pregnancy outcomes.
4 Important Questions Can ethanol stove intervention reduce personal exposure to PM 2.5, CO and PAH? What is the relationship between HAP exposure birth-weight and other pregnancy outcomes? Does HAP exposure lead to intrauterine growth restriction, impaired pulmonary function and changes in BP? Will participants use and adopt the ethanol stoves? Can ethanol stove intervention reduce systemic inflammation?
5 Objective of biomarker sub-study To determine if clean cookstove intervention will reduce serum levels of biomarkers of systemic inflammation and oxidative stress between 2 nd and 3 rd trimesters of pregnancy
6 Pathway
7 A randomized controlled stove intervention and pregnancy outcome 162 CleanCook stove/ethanol Randomized Controlled Intervention Trial Kerosene (104) or Firewood (58) Exclusion Smoker in home Cooking profession HIV infection Diabetes High risk pregnancy Last delivery end of October 2015
8 The CleanCook Tier 4 Stove* MacCarty N: Energy for Sus Dev 2010:
9 Biomarker Determination Serum biomarkers determined by ELISA in 2 nd and 3 rd Trimesters of pregnancy Pro-inflammatory markers IL- 6 IL-8 TNF-α Oxidative stress marker Malondialdehyde (MDA)
10 Exposure and cookstove monitoring 72 hour exposure monitoring for PM2.5 was performed during 2 nd and 3 rd trimesters of pregnancy SUMs placed on all stoves in study homes SUMs recorded temperature every 10 minutes *SUMs = Stove Use Monitors
11 SUMs monitoring confirms use and absence of stove stacking
12 Biomarker levels similar between Ethanol users and Controls Ethanol Intervention Control (Firewood OR Kerosene) n Mean Change SE n Mean Change SE P- Value IL-6 (pg/ml) IL-8 (pg/ml) TNF-α (pg/ml) MDA (pmol/ml)
13 Change from Kerosene to ethanol did not reduce inflammation Ethanol (From Kerosene) n Mean Change Control (Kerosene) SE n Mean Change SE P-Value IL-6 (pg/ml) IL-8 (pg/ml) TNF-α (pg/ml) MDA (pmol/ml)
14 Transition from firewood to ethanol stove reduced TNF-α levels Ethanol (From Firewood) n Mean Change Control (Firewood) SE n Mean Change SE P-Value IL-6 (pg/ml) IL-8 (pg/ml) TNF-α (pg/ml) * MDA (pmol/ml)
15 Log TNF- Log MDA Log RBP.5 1 Log IL Log IL Biomarker levels as a function of PM2.5 levels Log PM Log PM Log PM2.5 Rainy Season Dry Season Log PM Log PM2.5
16 Log TNF- Log MDA Log RBP.5 1 Log IL Log IL Biomarker levels as a function of Minutes above 100μg/m SQRT Minutes Above SQRT Minutes Above SQRT Minutes Above 100 Rainy Season Dry Season SQRT Minutes Above SQRT Minutes Above 100
17 Log TNFα Biomarker levels as a function of PM2.5 levels: TNF-α Slope estimate P-value Log RBP Log IL Log IL * Log PM2.5 Log TNF-α * Log MDA
18 Log IL-8 Biomarker levels as a function of PM2.5 levels: IL-8 Slope estimate P-value Log PM2.5 Log RBP Log IL Log IL * Log TNF-α * Log MDA
19 Conclusions Shifting to cleaner fuel and improved stoves reduces TNF-α during pregnancy There is linear correlation between PM2.5 and serum levels of TNF-α and IL-6 There was wide adoption of the CleanCook stove CleanCook stove with ethanol as fuel resulted in lower exposure to PM2.5 Sustained use and reduction in HAP may lead to reduction in systematic inflammation and thromboembolic risks
20 Limitations Relatively small sample size especially in the baseline firewood subgroup Inability to control for the effect of ambient air pollution and automobile-related pollution is an important confounder Lack of nutritional marker data to determine level of anti-oxidant defense
21 Ese Dr. Sola Olopade Ganiu Arinola, PhD Anindita Dutta, PhD Emily Bartlett Kristyna Hulland Dayo Adepoju Tope Ibigbami John Olajumilo
22 Appendix 1: Stove and Fuel Type Control Kerosene Stove Firewood stove (Three-Stone) Intervention Ethanol-fueled Stove Intervention NCT
23 Appendix 2: Study Design Kerosene 324 Pregnant Women Randomized at weeks Firewood (three-stone) Ethanol (CleanCook) 162 Control 162 Intervention Firewood (n=58) Kerosene (n=104) Firewood (n=51) Kerosene (n=111)
24 Appendix 3A: Participants Inclusion Criteria: 324 Pregnant Women - Apparently healthy women - Non-smokers and 162 Control 162 Intervention Firewood (n=58) Kerosene (n=104) Firewood (n=51) Kerosene (n=111) non-chewers of tobacco - Cooked regularly with firewood or kerosene - Less than 18 weeks gestational age (determined by self-reported first day of last menstrual period (LMP) and/or ultrasound biometry
25 Appendix 3B: Participants Exclusion Criteria: 324 Pregnant Women - Smoker - Lived with a smoker - Cooked for a living - HIV positive 162 Control 162 Intervention Firewood (n=58) Kerosene (n=104) - High-risk pregnancy (multiple gestations) - Uncontrolled material hypertension - Maternal age greater than 35 for first delivery - Three or more prior miscarriages - Prior C-section Firewood (n=51) Kerosene (n=111)
26 Appendix 4: Clinic 8 Clinic Visits Measurements: Ultrasound- intrauterine growth rate Birth weight and length Blood Draw for Biomarker analysis Blood Pressure Spirometry assesses lung function by measuring the amount of air that can be maximally inhaled and exhaled
27 Appendix 5: Characteristics of PM
28 Appendix 6A: Pathway
29 Appendix 6B: Pathway
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Benzo[a]Pyrene Update - A Game Changer for Environmental Remediation and Property Revitalization? April 28, 2017 Presented by Kristen Rivera What is Benzo[a]Pyrene (BaP)? Polycyclic aromatic hydrocarbon
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