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1.
Int Urogynecol J ; 31(9): 1851-1858, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-31813031

RESUMEN

INTRODUCTION AND HYPOTHESIS: Although pelvic floor disorders (PFDs) are a significant public health issue in higher income countries, less is known about these disorders and associated risk factors in low income countries. We aimed to determine prevalence and associated risk factors for stress urinary incontinence (SUI), urge urinary incontinence (UUI), and pelvic organ prolapse (POP) in reproductive age women in Sarlahi District in rural Nepal. METHODS: We conducted a community-based cross-sectional survey of parous, reproductive age women in rural Nepal and screened for pelvic floor disorders using validated screening questions for PFDs. Overall frequency of self-reported symptoms for SUI, UUI, and POP was estimated and compared across demographic and pregnancy history information. RESULTS: Of 14,469 women available for analysis, the mean (SD, range) age was 33.5 (8.2, 13-52) years, and median (range) number of pregnancies was 4 (1-15). The prevalence of SUI was 24.1% (95% CI: 23.3-24.8), of UUI was 13.5% (95% CI: 13.0-14.1), and of POP was 8.0% (95% CI: 7.5-8.4). Bivariate analysis identified the risk of PFD increased incrementally with age and number of vaginal deliveries; these covariates were highly correlated. Multivariable logistic regression revealed age, vaginal deliveries, and previous pelvic surgeries were independently associated with PFD. CONCLUSIONS: PFDs are common in a community of parous, reproductive age women in rural Nepal. Risk factors for these conditions are similar to risk factors found in higher income countries.


Asunto(s)
Prolapso de Órgano Pélvico , Incontinencia Urinaria de Esfuerzo , Incontinencia Urinaria , Adulto , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Nepal/epidemiología , Prolapso de Órgano Pélvico/epidemiología , Embarazo , Prevalencia , Incontinencia Urinaria de Esfuerzo/epidemiología
3.
Environ Res ; 142: 424-31, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-26245367

RESUMEN

Household air pollution from the burning of biomass fuels is recognized as the third greatest contributor to the global burden of disease. Incomplete combustion of biomass fuels releases a complex mixture of carbon monoxide (CO), particulate matter (PM) and other toxins into the household environment. Some investigators have used indoor CO concentrations as a reliable surrogate of indoor PM concentrations; however, the assumption that indoor CO concentration is a reasonable proxy of indoor PM concentration has been a subject of controversy. We sought to describe the relationship between indoor PM2.5 and CO concentrations in 128 households across three resource-poor settings in Peru, Nepal, and Kenya. We simultaneously collected minute-to-minute PM2.5 and CO concentrations within a meter of the open-fire stove for approximately 24h using the EasyLog-USB-CO data logger (Lascar Electronics, Erie, PA) and the personal DataRAM-1000AN (Thermo Fisher Scientific Inc., Waltham, MA), respectively. We also collected information regarding household construction characteristics, and cooking practices of the primary cook. Average 24h indoor PM2.5 and CO concentrations ranged between 615 and 1440 µg/m(3), and between 9.1 and 35.1 ppm, respectively. Minute-to-minute indoor PM2.5 concentrations were in a safe range (<25 µg/m(3)) between 17% and 65% of the time, and exceeded 1000 µg/m(3) between 8% and 21% of the time, whereas indoor CO concentrations were in a safe range (<7 ppm) between 46% and 79% of the time and exceeded 50 ppm between 4%, and 20% of the time. Overall correlations between indoor PM2.5 and CO concentrations were low to moderate (Spearman ρ between 0.59 and 0.83). There was also poor agreement and evidence of proportional bias between observed indoor PM2.5 concentrations vs. those estimated based on indoor CO concentrations, with greater discordance at lower concentrations. Our analysis does not support the notion that indoor CO concentration is a surrogate marker for indoor PM2.5 concentration across all settings. Both are important markers of household air pollution with different health and environmental implications and should therefore be independently measured.


Asunto(s)
Contaminación del Aire Interior/análisis , Biomasa , Monóxido de Carbono/análisis , Material Particulado/análisis , Pobreza , Culinaria , Fuentes Generadoras de Energía , Vivienda/normas , Vivienda/estadística & datos numéricos , Kenia , Nepal , Perú , Población Rural/estadística & datos numéricos
4.
Int J Environ Res Public Health ; 12(10): 13466-81, 2015 Oct 26.
Artículo en Inglés | MEDLINE | ID: mdl-26516875

RESUMEN

The influence of traffic-related air pollution on indoor residential exposure is not well characterized in homes with high natural ventilation in low-income countries. Additionally, domestic allergen exposure is unknown in such populations. We conducted a pilot study of 25 homes in peri-urban Lima, Peru to estimate the effects of roadway proximity and season on residential concentrations. Indoor and outdoor concentrations of particulate matter (PM2.5), nitrogen dioxide (NO2), and black carbon (BC) were measured during two seasons, and allergens were measured in bedroom dust. Allergen levels were highest for dust mite and mouse allergens, with concentrations above clinically relevant thresholds in over a quarter and half of all homes, respectively. Mean indoor and outdoor pollutant concentrations were similar (PM2.5: 20.0 vs. 16.9 µg/m³, BC: 7.6 vs. 8.1 µg/m³, NO2: 7.3 vs. 7.5 ppb), and tended to be higher in the summer compared to the winter. Road proximity was significantly correlated with overall concentrations of outdoor PM2.5 (rs = -0.42, p = 0.01) and NO2 (rs = -0.36, p = 0.03), and outdoor BC concentrations in the winter (rs = -0.51, p = 0.03). Our results suggest that outdoor-sourced pollutants significantly influence indoor air quality in peri-urban Peruvian communities, and homes closer to roadways are particularly vulnerable.


Asunto(s)
Contaminantes Atmosféricos/análisis , Contaminación del Aire Interior/análisis , Alérgenos/análisis , Polvo/análisis , Exposición a Riesgos Ambientales , Emisiones de Vehículos/análisis , Animales , Ciudades , Monitoreo del Ambiente , Humanos , Ratones , Ácaros , Dióxido de Nitrógeno/análisis , Material Particulado/análisis , Perú , Proyectos Piloto , Estaciones del Año , Hollín/análisis
5.
Int J Environ Res Public Health ; 11(10): 10310-26, 2014 Oct 03.
Artículo en Inglés | MEDLINE | ID: mdl-25286166

RESUMEN

Global efforts are underway to develop and promote improved cookstoves which may reduce the negative health and environmental effects of burning solid fuels on health and the environment. Behavioral studies have considered cookstove user practices, needs and preferences in the design and implementation of cookstove projects; however, these studies have not examined the implications of the traditional stove use and design across multiple resource-poor settings in the implementation and promotion of improved cookstove projects that utilize a single, standardized stove design. We conducted in-depth interviews and direct observations of meal preparation and traditional, open-fire stove use of 137 women aged 20-49 years in Kenya, Peru and Nepal prior in the four-month period preceding installation of an improved cookstove as part of a field intervention trial. Despite general similarities in cooking practices across sites, we identified locally distinct practices and norms regarding traditional stove use and desired stove improvements. Traditional stoves are designed to accommodate specific cooking styles, types of fuel, and available resources for maintenance and renovation. The tailored stoves allow users to cook and repair their stoves easily. Women in each setting expressed their desire for a new stove, but they articulated distinct specific alterations that would meet their needs and preferences. Improved cookstove designs need to consider the diversity of values and needs held by potential users, presenting a significant challenge in identifying a "one size fits all" improved cookstove design. Our data show that a single stove design for use with locally available biomass fuels will not meet the cooking demands and resources available across the three sites. Moreover, locally produced or adapted improved cookstoves may be needed to meet the cooking needs of diverse populations while addressing health and environmental concerns of traditional stoves.


Asunto(s)
Actitud/etnología , Culinaria/métodos , Características Culturales , Países en Desarrollo , Artículos Domésticos , Adulto , Culinaria/instrumentación , Diseño de Equipo , Femenino , Humanos , Kenia , Persona de Mediana Edad , Nepal , Perú
6.
Trials ; 14: 327, 2013 Oct 10.
Artículo en Inglés | MEDLINE | ID: mdl-24112419

RESUMEN

BACKGROUND: Exposure to biomass fuel smoke is one of the leading risk factors for disease burden worldwide. International campaigns are currently promoting the widespread adoption of improved cookstoves in resource-limited settings, yet little is known about the cultural and social barriers to successful improved cookstove adoption and how these barriers affect environmental exposures and health outcomes. DESIGN: We plan to conduct a one-year crossover, feasibility intervention trial in three resource-limited settings (Kenya, Nepal and Peru). We will enroll 40 to 46 female primary cooks aged 20 to 49 years in each site (total 120 to 138). METHODS: At baseline, we will collect information on sociodemographic characteristics and cooking practices, and measure respiratory health and blood pressure for all participating women. An initial observational period of four months while households use their traditional, open-fire design cookstoves will take place prior to randomization. All participants will then be randomized to receive one of two types of improved, ventilated cookstoves with a chimney: a commercially-constructed cookstove (Envirofit G3300/G3355) or a locally-constructed cookstove. After four months of observation, participants will crossover and receive the other improved cookstove design and be followed for another four months. During each of the three four-month study periods, we will collect monthly information on self-reported respiratory symptoms, cooking practices, compliance with cookstove use (intervention periods only), and measure peak expiratory flow, forced expiratory volume at 1 second, exhaled carbon monoxide and blood pressure. We will also measure pulmonary function testing in the women participants and 24-hour kitchen particulate matter and carbon monoxide levels at least once per period. DISCUSSION: Findings from this study will help us better understand the behavioral, biological, and environmental changes that occur with a cookstove intervention. If this trial indicates that reducing indoor air pollution is feasible and effective in resource-limited settings like Peru, Kenya and Nepal, trials and programs to modify the open burning of biomass fuels by installation of low-cost ventilated cookstoves could significantly reduce the burden of illness and death worldwide. TRIAL REGISTRATION: ClinicalTrials.gov NCT01686867.


Asunto(s)
Contaminantes Atmosféricos/efectos adversos , Contaminación del Aire Interior/efectos adversos , Culinaria/instrumentación , Países en Desarrollo/economía , Artículos Domésticos , Vivienda , Enfermedades Pulmonares/prevención & control , Proyectos de Investigación , Humo/efectos adversos , Adulto , Presión Sanguínea , Monóxido de Carbono/metabolismo , Estudios Cruzados , Características Culturales , Monitoreo del Ambiente , Diseño de Equipo , Espiración , Estudios de Factibilidad , Femenino , Volumen Espiratorio Forzado , Conocimientos, Actitudes y Práctica en Salud , Humanos , Exposición por Inhalación/efectos adversos , Kenia , Pulmón/fisiopatología , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/etiología , Enfermedades Pulmonares/fisiopatología , Persona de Mediana Edad , Nepal , Ápice del Flujo Espiratorio , Perú , Factores de Riesgo , Factores de Tiempo
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