Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries.

Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from -90% to +30%, were reported in many countries following early COVID-19 pandemic response measures ('lockdowns'). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95-0.98, P value <0.0001), second (0.96, 0.92-0.99, 0.03) and third (0.97, 0.94-1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96-1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88-1.14, 0.98), third (0.99, 0.88-1.12, 0.89) and fourth (1.01, 0.87-1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02-1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03-1.15, 0.002), third (1.10, 1.03-1.17, 0.003) and fourth (1.12, 1.05-1.19, <0.001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways.

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017.

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

Street vending and waste picking in developing countries: a long-standing hazardous occupational activity of the urban poor.

Uncontrolled urbanization in developing countries has led to widespread urban poverty and increased susceptibility to environmental exposures owing to the hazardous occupational activities of the urban poor. Street vending and waste picking are the dominant works undertaken by the urban poor, and besides the physical hazards, it also exposes them to several pathogens and high levels of air pollutants present in the outdoor environment. The situation has severe consequences for the health of the workers. Eliminating these occupational activities from the urban landscape of developing countries should therefore receive urgent attention from the global health community and governments. In this article, we provide evidence to support this policy recommendation by documenting exposure experiences of the workers, the associated adverse health effects, whilst also outlining measures for addressing the problem sustainably. We conclude that with the adoption of the sustainable development goals (SDG), governments now have a commitment to address poverty and the associated occupational health hazards experienced by the poor through their choices to help achieve the health-related SDG target (3.9) of substantially reducing the number of deaths and illnesses from hazardous chemicals and air, water, and soil pollution and contamination by 2030.

Household air pollution and the sustainable development goals.

Globally, 41% of households, over 2.8 billion people, rely on solid fuels (coal and biomass) for cooking and heating. In developing countries in Asia and sub-Saharan Africa where these fuels are predominantly used, women who are customarily responsible for cooking, and their young children, are most exposed to the resulting air pollution. Solid fuels are still in widespread use and it appears that intervention efforts are not keeping pace with population growth in developing countries. Here we pinpoint the challenges and identify opportunities for addressing household air pollution while mitigating global climate change and promoting the sustainable development goals. We recommend the following actions: implementation of the WHO indoor air quality guidelines on household fuel combustion; effective promotion and dissemination of improved cookstoves through formation of country alliances for clean cookstoves; expansion of liquefied petroleum gas production facilities and distribution networks; harnessing renewable energy potential; promotion of biogas production at both household and community level; ensuring improved ventilation of homes through education and enforcement of building standards; and exploiting opportunities in the health and other sectors for changing health-damaging cooking behaviour.

Dans le monde, 41% des foyers, à savoir plus de 2,8 milliards de personnes, utilisent des combustibles solides (charbon et biomasse) pour cuisiner et se chauffer. Dans les pays en développement d'Asie et d'Afrique subsaharienne, où ces combustibles sont majoritairement utilisés, les femmes, qui s'occupent habituellement de la cuisine, et les jeunes enfants sont les plus exposés à la pollution de l'air en résultant. Les combustibles solides sont encore très répandus et il apparaît que les actions menées ne progressent pas au même rythme que la croissance de la population dans les pays en développement. Nous identifions ici les difficultés et les possibilités de lutte contre la pollution de l'air domestique et, dans le même temps, les possibilités d'atténuation du changement climatique et de promotion des objectifs de développement durable.Nous recommandons les actions suivantes: application des lignes directrices de l'OMS relatives à la qualité de l'air intérieur et à l'utilisation de combustibles dans les habitations; promotion et diffusion de modes de cuisson propres par la formation d'alliances pour des réchauds écologiques; développement de sites de production et de réseaux de distribution de gaz de pétrole liquéfié; exploitation du potentiel des énergies renouvelables; promotion de la production de biogaz au niveau des foyers et de la communauté; meilleure ventilation des logements à travers l'éducation et le respect des normes de construction; mise à profit des opportunités dans le secteur de la santé, entre autres, pour changer les comportements nuisibles à la santé lors de la préparation des repas.

El 41% de los hogares de todo el mundo, es decir, más de 2 800 millones de personas, depende de combustibles sólidos (carbón y biomasa) para la cocina y la calefacción. En países en desarrollo de Asia y del África subsahariana, en los cuales se utiliza principalmente este tipo de combustibles, las mujeres suelen ser las responsables de cocinar, por lo que sus hijos son los que más expuestos están a la contaminación del aire derivada de estas tareas. Los combustibles sólidos siguen utilizándose de forma generalizada y parece que los esfuerzos de intervención no están manteniendo el ritmo del crecimiento poblacional de los países en desarrollo. Aquí se detectan los problemas y se identifican las oportunidades para tratar la contaminación del aire en los hogares, a la vez que se mitiga el cambio climático global y se fomentan los objetivos de desarrollo sostenible. Se recomienda tomar las siguientes medidas: la implementación de las normativas de la OMS para la calidad del aire interior en relación con los combustibles domésticos; el fomento y difusión eficaces de mejores cocinas mediante la formación de alianzas entre países para unas cocinas limpias; la expansión de instalaciones de producción de gas licuado del petróleo, tanto en los hogares como en las comunidades; el aprovechamiento potencial de las energías renovables; la promoción de la producción de biogás tanto en los hogares como en la comunidad; la garantía de una mejor ventilación en los hogares educando y fomentando los estándares de construcción; y el aprovechamiento de las oportunidades tanto en el sector sanitario como en otros sectores para cambiar el comportamiento perjudicial para la salud en las cocinas.

Work as a street vendor, associated traffic-related air pollution exposures and risk of adverse pregnancy outcomes in Accra, Ghana.

BACKGROUND: Street vending, a dominant occupation in urban areas of developing countries exposes the vendors to several environmental pollutants. We investigated whether work as street vendor impairs foetal growth and shortens gestational duration, and evaluated to what extent exposure to traffic-related air pollution is responsible for these adverse effects. METHODS: A cross-sectional study was conducted among mothers and their newborns accessing postnatal services at the Korle Bu Teaching Hospital in Accra, Ghana in 2010, focusing on 105 street vendors and a reference group of 281 mothers. We categorized exposure to traffic-related air pollution on the basis of street vending activity patterns and traffic density in the working area. RESULTS: Multivariate linear regression analysis adjusting for age, social class, marital status and gravidity of mothers, sex of neonate, and indoor air pollution, indicated a 177 g (95% CI: 324, 31) reduction in birth weight among street vendors. Sensitivity analysis performed by restricting the analysis to term births showed further reductions in birth weight. Generalized linear models adjusting for confounders indicated a 35% (risk ratio (RR)=1.35; 95% CI: 0.87, 2.12) increased risk of LBW, albeit statistically not significant. LBW risk increased in the sensitivity analysis but was also not statistically significant. The risk of PTB was not associated with street vending (RR=1.03; 95% CI: 0.67, 1.58). The exposure-response relations observed were not consistent. Moderate activity patterns and high traffic density jointly was associated with a statistically significant 84% (RR=1.84; 95% CI: 1.05, 3.24) increased risk of LBW. CONCLUSION: Street vending during pregnancy is a determinant of average foetal growth and risk of LBW. More research is required to further quantify their effects on pregnancy outcomes and safeguard maternal and perinatal health in developing countries.