BACKGROUND AND AIM: Exposure to indoor air pollution from biomass fuels is a major health burden in developing countries. Birth outcomes determine the health status in later life.Aim of the study is to compare birth outcomes among female residents in households using a mixture of cooking fuels during pregnancy. METHOD: Pregnant mothers (n = 475) in the third trimester of the pregnancy were recruited and followed up. Birth weight, occipitofrontal circumference (OFC), and length of the newborn babies were ascertained from the Child Health Development Record. The study sample was categorized into two groups based on the cleanliness of cooking fuel (e.g., clean fuel - electricity, liquid petroleum gas vs. unclean fuel – wood, kerosene). The kitchen PM2.5 were monitored for 24 hours in a subsample of households, every six months over the two years since the birth of the child. RESULTS: Primary cooking fuel in 167 (35.2%) households were clean fuel. Secondary cooking fuel was used by 380 (80.0%) households and tertiary cooking fuel was used by 161 (33.9%) households. There were 446 (95.1%) term babies and 23 (4.9%) pre-term babies. There were 17 (10.2%) Low Birth weight(2500g) babies in clean energy-using households and 44 (14.3%) in unclean clean energy-using households as primary cooking fuel. Prematurity was less among mothers in households using a clean primary cooking fuel (3.6%) as compared to mothers in households using an unclean primary cooking fuel (4.9%). PM2.5 monitoring every six months and four times in a sample of households (n = 81) showed that the PM2.5 concentration is 2-3 times higher in the unclean primary fuel-using households. CONCLUSIONS: Majority of the households use more than one cooking fuel (i.e., unclean or clean). Using a mixture of fuel types reduces exposures and improves birth outcomes, but relying on 100% clean energy would improve the birth outcomes further.

Background. Fly ash from coal-fired power plants (CPP) often consist of trace heavy metals such as arsenic and lead which have been linked with deleterious health effects in exposed communities. Objective. A cross-sectional study examined relationship between proximity to CPP, an indirect measure for environmental exposure to flyash, and neurodevelopment in infants 1- 3 years of age, measured using 'Bayley Scales of Infant and Toddler Development, third edition (BSID-III)' Methods. Set in Puttalam District in Sri Lanka, the study enrolled 208 children: 108 from the buffer zones around the CPP with radii of '<5kms' and 100 from '≥10kms', respectively. In a multivariable general linear regression, we analyzed the relationship between proximity to CPP and BSID-III cognitive, motor and language scores, adjusting for maternal age, ethnicity, wealth index, and child's age, sex and birthweight. Results. On average, children were 23.4 months (±6.4) old and 60.2% were female. Compared to children residing away from the CPP (≥10 kms), children residing in close proximity (<5 kms) had lower composite scores for BSID-III language (adj. means: 93.7 vs. 88.8, p= 0.0057), motor (88.0 vs. 86.0, p=0.2126) and cognitive (84.4 vs. 83.1, p= 0.4395) but only language was significant, after adjusting for covariates. Discussion. Our findings suggest lower developmental scores among children residing closer to CPP compared to those further away. Results of the study have scientific and policy implications for low- and middle-income countries as well as developed countries like US, where low-income, minority, rural and inner-city urban communities continue to disproportionately be exposed to higher levels of trace heavy metals released from industrial effluents, mining, fertilizers, and pharmaceuticals. Keywords: Flyash, Coal, Children, Infant neurodevelopment, Bayley

Air pollution is a multifaceted environmental toxin affecting the Central Nervous System (CNS) through diverse pathways. The CNS of young children is particularly susceptible to the detrimental effects of toxins, as brain development continues postnatally with the formation of interneuronal connections, glial cell proliferation and myelination of axons. Indoor air pollution (IAP) from solid fuel combustion is more harmful than outdoor air pollution. Numerous air pollutants hazardous to health are released during the burning of unprocessed biomass. The primary source of fuel in Sri Lanka for cooking is biomass, mainly wood. In this study, we evaluated the influence of IAP resulting from biomass combustion on the neurodevelopment of children. In a cohort of children under five years living in a semi-urban area of Sri Lanka, neurodevelopment was assessed using Denver II developmental screening test. Air quality levels were measured (Carbon Monoxide (CO) and Particulate Matter 2.5 (PM2.5)) in a subsample. There were significantly high levels of CO and PM2.5 in the ambient air of households using biomass as the primary fuel for cooking. Children living in these households had a significantly higher number of children with 'suspect' developmental assessment scores in the language, social behavior and play and gross motor development domains.

Objective: - To evaluate exposure-response relationships between 1,3-butadiene and styrene and selected diseases among synthetic rubber polymer workers. Methods: - 21,087 workers (16,579 men; 4508 women) were followed from 1943 through 2009 to determine mortality outcomes. Cox regression models estimated rate ratios (RRs) and 95% confidence intervals (CIs) by quartile of cumulative exposure to butadiene or styrene and exposure-response trends for cancers of the bladder, lung, kidney, esophagus and pancreas, and for all nonmalignant respiratory disease (NMRD), chronic obstructive pulmonary disease (COPD) and pneumonia. Results: - Bladder cancer RRs were 2.13 (95% CI = 1.03 to 4.41) and 1.64 (95% CI = 0.76 to 3.54) in the highest quartiles of cumulative exposure to butadiene and styrene, respectively, and exposure-response trends were positive for both monomers (butadiene, trend p = 0.001; styrene, trend p = 0.004). Further analyses indicated that the exposure-response effect of each monomer on bladder cancer was demonstrated clearly only in the subgroup with high cumulative exposure (at or above the median) to the other monomer. Lung cancer was not associated with either monomer among men. Among women, lung cancer RRs were above 1.0 in each quartile of cumulative exposure to each monomer, but exposure-response was not seen for either monomer. Male workers had COPD RRs slightly above 1.0 in each quartile of cumulative exposure to each monomer, but there was no evidence of exposure-response among the exposed. Monomer exposure was not consistently associated with COPD in women or with the other cancer outcomes. Conclusions: - This study found a positive exposure-response relationship between monomer exposures and bladder cancer. The independent effects of butadiene and styrene on this cancer could not be delineated. In some analyses, monomer exposure was associated with lung cancer in women and with COPD in men, but inconsistent exposure-response trends and divergent results by sex do not support a causal interpretation of the isolated positive associations.

ObjectiveTo evaluate exposure–response between 1,3-butadiene, styrene and lymphohaematopoietic cancers in an updated cohort of workers at six North American plants that made synthetic rubber polymers.MethodsEmployees were followed from 1943 through 2009 to determine mortality outcomes. Cox regression analyses estimated rate ratios (RRs) and 95% CIs by quartile of cumulative exposure to butadiene or styrene, measured in parts per million-years (ppm-years), and exposure–response trends for all leukaemia, lymphoid leukaemia, myeloid leukaemia, acute myeloid leukaemia, non-Hodgkin’s lymphoma (NHL), multiple myeloma and all B-cell malignancies.ResultsAmong 21 087 workers, adjusted RRs for butadiene and all leukaemia (132 deaths) rose with increasing exposure, with an RR of 2.53 (95% CI 1.37 to 4.67) in the highest exposure quartile (≥363.64 ppm-years), and the exposure–response trend was statistically significant for all leukaemia (p=0.014) and for lymphoid leukaemia (52 deaths, p=0.007). Styrene exposure–response trends for all leukaemia and lymphoid leukaemia were less consistent than those for butadiene. Cumulative exposures to butadiene and styrene were not associated consistently with myeloid leukaemias or the B-cell malignancies, NHL and multiple myeloma.ConclusionsWe confirmed a positive exposure–response relationship between butadiene and all leukaemia among workers, most of whom had coexposure to styrene. Results supported an association between butadiene and lymphoid leukaemia, but not myeloid leukaemia, and provided little evidence of any association of butadiene or styrene exposures with major subtypes of B-cell malignancies other than lymphoid leukaemia, including NHL and multiple myeloma.

Solid fuel combustion is an important risk factor of morbidity. This study was conducted to determine the effect of indoor air pollution (IAP) due to solid fuel combustion on physical growth in 262 Sri Lankan children under five. Exposure was defined by the type of fuel used for cooking. Pollutant levels were measured in a subsample of households. "High" exposure group (households using biomass fuel/kerosene oil for cooking) comprised 60% of the study population; the prevalence of wasting was 19.7% and underweight was 20.4% in the entire population where 68% were from the high exposure group. Children from the "high" exposure group had significantly lower mean z-scores for weight-for-height (p = 0.047), height-for-age (p = 0.004) and weight-for-age (p = 0.001) as compared to the "low" exposure group (children of households using liquefied petroleum gas and/or electricity) after adjusting for confounders. Z-scores of weight-for-age, height-for-age and weight-for-height were negatively correlated with CO (p = 0.001, 0.018, 0.020, respectively) and PM2.5 concentrations (p<0.001,p = 0.024 p = 0.008, respectively). IAP due to combustion of biomass fuel leads to poor physical growth.

Context: Diabetes is one of the leading causes of morbidity and mortality worldwide. India has the second highest number of individuals with diabetes in the world and these numbers are predicted to reach 120 million by 2045. Environmental exposure to particulate matter and nitrogen dioxide has been identified as a risk factor for diabetes However, to date, no published studies have examined the association of indoor air pollution (IAP) and diabetes in developing countries such as India, where traditional biomass fuels are still used for cooking and heating. Aims: To evaluate the association between IAP and diabetes mellitus. Settings and Design: The data collected through India's third National Family Health Survey (NFHS-3) in 2005–2006 were queried and analyzed. Materials and Methods: This study examined the association between IAP and diabetes among women aged 45 years and above using data from the NFHS-3. Statistical Analysis: Multivariable regression analysis was used to determine the relationship between diabetes and type of fuel, calculate adjusted odds ratios (OR) and the 95% confidence interval (CI) after adjusting for confounders. Results: Less than 1/3 of the 9,502 (28%) participants were overweight or obese and 304 women reported having diabetes. A statistically significant association between solid fuel use and diabetes in women >45 years of age was observed (OR: 1.59; 95% CI: 1.08–2.34). Conclusions: This study is the first attempt to determine the relationship between diabetes and IAP; more robust population-based cohort studies are needed to further explore this association.

Maternal health and Non-communicable Disease (NCD) are closely linked. NCDs in pregnancy lead to serious complications during pregnancy and delivery and in newborns. The management and treatment of pregnant women with NCDs have been compromised by the coronavirus disease 2019 (COVID-19) pandemic, which has brought to the forefront the deficiencies in the healthcare systems globally. Measures such as lockdowns, social distancing, and transportation restrictions impact maternal healthcare by disrupting access and continuity of care for NCDs and to preventive and health promotion services. In parallel, it negatively impacts the global progress made in decreasing the maternal and neonatal mortality rates (MMR and NMR) in the lower and middle-income countries. There is an urgent need to incorporate maternal health with a focus on high-risk pregnancies into the response measures for COVID-19 and in the planning of preparedness of future pandemics if the Sustainable Development Goals targets for MMR and NMR are to achieve by 2030.

PURPOSE:To advocate perspectives to strengthen existing healthcare systems to prioritize maternal health services amidst and beyond the COVID-19 pandemic in low- and middle income countries.DESCRIPTION:COVID-19 directly affects pregnant women causing more severe disease and adverse pregnancy outcomes. The indirect effects due to the monumental COVID-19 response are much worse, increasing maternal and neonatal mortality.ASSESSMENT:Amidst COVID-19, governments must balance effective COVID-19 response measures while continuing delivery of essential health services. Using the World Health Organization's operational guidelines as a base, countries must conduct contextualized analyses to tailor their operations. Evidence based information on different services and comparative cost-benefits will help decisions on trade-offs. Situational analyses identifying extent and reasons for service disruptions and estimates of impacts using modelling techniques will guide prioritization of services. Ensuring adequate supplies, maintaining core interventions, expanding non-physician workforce and deploying telehealth are some adaptive measures to optimize care. Beyond the COVID-19 pandemic, governments must reinvest in maternal and child health by building more resilient maternal health services supported by political commitment and multisectoral engagement, and with assistance from international partners.CONCLUSIONS:Multi-sectoral investments providing high-quality care that ensures continuity and available to all segments of the population are needed. A robust primary healthcare system linked to specialist care and accessible to all segments of the population including marginalized subgroups is of paramount importance. Systematic approaches to digital health care solutions to bridge gaps in service is imperative. Future pandemic preparedness programs must include action plans for resilient maternal health services.

More than 70% of the annual global deaths are due to noncommunicable diseases (NCDs), and 80% of these deaths occur in low- and middle-income countries. Most of these deaths are in people <70 years of age and can be prevented and controlled by addressing a set of modifiable risk factors, namely tobacco use, alcohol misuse, unhealthy diets, physical inactivity, and obesity. Recognizing the global burden of NCDs, the world's leaders adopted several policy instruments such as the NCD Global Action Plan, the Framework Convention on Tobacco Control, and the global monitoring framework on NCDs. In 2015, the UN General Assembly included reduction of premature mortality from NCDs by one-third by 2030 as target 3.4 of the Sustainable Development Goals (SDGs). Assessment of this target in 2018 found some progress with tobacco control, but the overall progress was inadequate. The global pandemic of coronavirus disease 2019 (COVID-19) has brought NCDs to the forefront. Preliminary data indicate that persons with NCDs are extremely susceptible to COVID-19 and its complications including death. Focus on controlling the pandemic has led to delays in the diagnosis, treatment, and management of NCDs. This pandemic has exposed the weaknesses of the health-care systems, exacerbated the inequalities within societies, and disproportionately affected the vulnerable groups. In the process of recovery and in future planning, governments and leaders need to take proactive actions toward the prevention and control of all avoidable deaths from NCDs if the SDG target 3.4 is to be achieved by 2030.

Objective To design and implement a locally relevant competency- based MPH programme. Methods The demand for trained public health professionals in South Asia is enormous and growing, which created a unique opportunity for a Fogarty International Center-funded University of Alabama at Birmingham-South Asia [Aga Khan University, Pakistan; Manipal Academy of Higher Education, India; and University of Kelaniya, Sri Lanka] international research training in environmental and occupational health (ITREOH) programme. In 2009, a Master of Public Health (MPH) degree programme was designed using a combination of competencies developed by the Association of School of Public Health, the World Health Organization and the Centers for Disease Control and Prevention. Results A competency- based curriculum was developed with two specialty tracks in applied epidemiology and environmental and occupational health, emphasising applied practice and research. Conclusions This is the most comprehensive skill-based MPH programme in the region, which positions each institution as a regional leader in public health training. The success of the programme has been amply demonstrated by placements of graduated MPH students in leadership roles in public, private and academic sectors within their countries.

Household air pollution from combustion of solid fuels for cooking and space heating is one of the most important risk factors of the global burden of disease. This study was aimed to determine the association between household air pollution due to combustion of biomass fuel in Sri Lankan households and self-reported respiratory symptoms in children under 5 years. A prospective study was conducted in the Ragama Medical Officer of Health area in Sri Lanka. Children under 5 years were followed up for 12 months. Data on respiratory symptoms were extracted from a symptom diary. Socioeconomic data and the main fuel type used for cooking were recorded. Air quality measurements were taken during the preparation of the lunch meal over a 2-h period in a subsample of households. Two hundred and sixty two children were followed up. The incidence of infection induced asthma (RR = 1.77, 95%CI;1.098–2.949) was significantly higher among children resident in households using biomass fuel and kerosene (considered as the high exposure group) as compared to children resident in households using Liquefied Petroleum Gas (LPG) or electricity for cooking (considered as the low exposure group), after adjusting for confounders. Maternal education was significantly associated with the incidence of infection induced asthma after controlling for other factors including exposure status. The incidence of asthma among male children was significantly higher than in female children (RR = 1.17; 95% CI 1.01–1.37). Having an industry causing air pollution near the home and cooking inside the living area were significant risk factors of rhinitis (RR = 1.39 and 2.67, respectively) while spending less time on cooking was a protective factor (RR = 0.81). Houses which used biomass fuel had significantly higher concentrations of carbon monoxide (CO) (mean 2.77 ppm vs 1.44 ppm) and particulate matter2.5 (PM2.5) (mean 1.09 mg/m3 vs 0.30 mg/m3) as compared to houses using LPG or electricity for cooking. The CO and PM2.5 concentrations were significantly higher in households using biomass fuel for cooking. There was a 1.6 times higher risk of infection induced asthma (IIA) among children of the high exposure group as compared to children of the low exposure group, after controlling for other factors. Maternal education was significantly associated with the incidence of IIA after controlling for exposure status and other variables.

OBJECTIVE To evaluate 1943-2009 mortality among 22,785 synthetic rubber industry employees. METHODS Standardized mortality ratio (SMR) and internal Cox regression analyses. RESULTS Among hourly employees with ≥10 years worked and ≥20 years since hire, SMRs were elevated for leukemia (SMR = 139, 95% confidence interval (CI) = 106-179), non-Hodgkin lymphoma (NHL) (SMR = 136, CI = 102-177), bladder cancer (SMR = 148, CI = 110-195) and, for women only, lung cancer (SMR = 225, CI = 103-427). Butadiene and styrene exposure-response trends were positive for leukemia and bladder cancer but not for NHL or for lung cancer among women. CONCLUSIONS Results support a causal relationship between butadiene and leukemia. Interpretation of results for lung cancer among women and for bladder cancer is uncertain because of inability to control for smoking and inadequate or inconsistent support from other studies for an association between butadiene or styrene and the latter cancers.

The cookstove determines the fuel type to be used for combustion. The amount of emission and composition of air pollutants is based on the fuel and cookstove type which is varied geographically. Combustion of solid fuel for cooking purpose is the key source of household air pollution in many developing countries leading to various adverse health impacts. Health impact due to solid fuel combustion for cooking are in respiratory system (i.e., lower respiratory tract infections, chronic obstructive pulmonary disease), cardiovascular system (e.g., high blood pressure, elevations in electrocardiograms), pregnancy (e.g., low birth weight, stillbirths); causes cancer (e.g., lung cancer), and affect neurodevelopment of young children. Appropriate interventions and techniques could prevent and control the household air pollution by minimising the emission from the source (e.g., shifting from solid fuels to clean fuels) improving the living environment (e.g., increase the ventilation by having windows, doors and chimney in the kitchen; and modifying the behaviour and practices of cookstove users (e.g., amount and type of solid fuel use).

OPS 09: Cookstoves and children, Room 114, Floor 1, August 26, 2019, 1:30 PM - 3:00 PM Background/aim. Prenatal exposure to household air pollution (hap) is linked with several adverse health effects in children, but evidence is limited for child neurodevelopment. We evaluated the association between prenatal hap exposure and child neurodevelopment at 1.5 and 3.0 years of age, in a birth-cohort study of 545 mother-child pairs in Sri Lanka. Methods. Prenatal exposure to hap was ascertained from questionnaires; additional 2-hour area measurements for particulate matter of size ≤2.5μm (pm2.5) were conducted in 56% of households (n=303). The Bayley scales of infant development (Bayley) iii assessed child's cognitive, fine and gross motor development at 1.5 and 3 years. Linear regression models were used to determine the association between hap and developmental outcomes. Results. At 1.5 years, children of wood-using households had lower cognitive (adj. means, 101 vs. 103, p = 0.09) and motor scores (107 vs. 109, p = 0.06) on Bayley iii compared to children in lpg households, adjusted for covariates. At 3.0 years, children in households using wood had lower cognitive scores on Bayley iii (88 vs. 90, p = 0.06) compared to lpg using households, respectively. A unit increase in log-transformed pm2.5 (10% increase on pm2.5) was significantly associated with decrements in cognitive scores (β= -0.58, se =0.26, p=0.02). Lower scores for cognition on bayley iii (p=0.03) were associated with increasing wood use, adjusted for covariates; exposure-response trend was significant across the three fuel use categories (100% LPG use, 50-100% LPG use and <50% wood use, and >50% wood use p<0.05). Differences in fine and gross motor scores for bayley iii by exposure status at 3.0 years were unremarkable. Conclusion. The results of the study indicate the potential neurotoxic impact of hap on child's cognitive scores with the impact continuing through early childhood.

Background/Aim. Most air pollution studies model exposure using large geographical units (city/county), resulting in exposure misclassification. In this study we evaluated the relationship between zip-code specific ambient air pollutants and emergency department visits (EDV) for respiratory diseases (RDs) in Jefferson County (JC), Alabama.Methods. EDV records for adult patients (≥18 years) for RDs were obtained from eight of 11 hospitals in JC from 1999-2009. Data on PM2.5 μg/m3, PM10 μg/m3, ozone and speciated compounds from JC monitors were used to model daily exposures for the 67 residential zip codes. Using GAM with Poisson log-link function and splines, risk ratios were computed, adjusting for covariates. Expanded analysis included single-day and moving-average lagged exposure, alternately adjusting for average or range temperature and stratification by seasons.Results. A positive association between PM2.5 (RR, 1.002, 95%CI, 1.002-1.003) and PM10 (RR, 1.003; 95%CI, 1.003-1.004) and all RD was noted; results were similar for upper respiratory infection (URI) and asthma. Ozone was negatively associated with all RDs (RR, 0.999; 95%CI, 0.998 - 0.999), asthma and URI, limited to winter months (RR, 0.996; 95%CI, 0.995 - 0.997); summer months, (RR,1.00; 95%CI, 0.999-1.0004). Speciated pollutants including CO, EC, MMO, NH4, NO3, OC, SO2, SO4, and TC were positively associated with all RDs, URI and asthma. Strongest associations were noted for 0-8 days moving-average lagged PM and speciated pollutants, particularly NH4 (RR, 1.022; 95%CI, 1.011-1.033); NO3 (RR, 1.914; 95%CI, 1.812-2.02), OC (RR, 1.03; 95%CI, 1.023-1.037); and TC (RR, 1.018; 95%CI, 1.012-1.025) and asthma; similar patterns were observed for all RDs and URI.Conclusions. PM10, PM2.5 and speciated pollutants increase risk of ED visits for RDs in adults with stronger effects observed with lagged exposures. Possible effect modification by seasons for ozone exposure and RDs were observed.

Background and aims: The Neonatal Behavior Assessment Scale (NBAS) was introduced by Brazelton is a useful tool to assess neurodevelopment in newborn in research setting. However, it is complex, time-consuming and requires specialized training for administration and is therefore difficult tool to use in routine clinical settings. The Alberta Infant Motor Scale (AIMS) is a simple tool to assess of motor maturation of a child up to 18 months and can be administered with minimal training for the health care professionals. The study goal of this study was to evaluate the reliability and validity of the AIMS in comparison with the NBAS in assessing motor maturity at birth. Methods: We administered the AIMS and NBAS to a total of 66 newborn babies delivered in three obstetric units at the Colombo North Teaching Hospital in Ragama, Sri Lanka. The subjects were selected from a sample of 545 newborn babies in an ongoing birth-cohort study evaluating effects of prenatal exposure to biomass smoke and infant neurodevelopment. Trained research assistants administered first the NBAS, followed by the AIMS one-hour later. Univariate and bivariate statistics were used to compare the two scales.Results: Irrespective of maturity, sex, birth weight or socio-demographic characteristics, all babies had scored on the 75th percentile in the AIMS. In the NBAS, there was a significant variation in the Brazelton motor score scaled to 100. Low birth weight babies showed a narrower variation in the NABS score. None of the scales indicated a motor deficit in any of the children.Conclusion: NBAS identifies subtle differences in motor maturity of full term babies that the AIMS fails to detect.

Objective: To determine the seroprevalence of varicella zoster virus（VZV） antibodies among the population residing in the Colombo district of Sri Lanka. Methods: A cross-sectional population-based study was conducted which included 1 258 participants. Blood samples were collected and questionnaires administered to obtain sociodemographic information and history of varicella and/or herpes zoster. Serum samples were assayed for VZV IgG antibodies using a commercial enzyme-linked immunosorbent assay kit. Results: Overall, the seroprevalence was 54.2%（95% CI= 51.5% 57.0%）. Children below 1 year of age were seronegative, and only about 20.0% of children between 1 and 10 years of age were seropositive. Seropositivitiy increased with age and by the age of 40 years 74.3% were seropositive. Among women of childbearing age, the overall seroprevalence was about 62.0%（95% CI = 57.7%-66.1%） but was low 37.0% in the 15-19 age group. Conclusion: In this population, 45.8% lacked natural immunity against varicella. Of women of childbearing age, 39.9% lacked immunity and in the subgroup of women 15-19 years of age, 63.0% women lacked immunity. In light of the country’s success with the control and high coverage of other vaccine preventable diseases and that the vaccine is available in the private sector, the inclusion of varicella vaccine in the national immunization program may be considered.

Introduction. Environmental air pollution is an important contributor to the global burden of respiratory disease among children. We examined the effects of PM10, ozone, PM2.5 and its speciated compounds, on emergency department (ED) visits for respiratory diseases (RDs) among children, in Jefferson County (JC), Alabama.Methods. Daily exposure to air pollutants was characterized as county-wide aggregate and by residential zip codes. Daily counts of ED admissions for RDs, upper respiratory infections (URI) and asthma in children below 18 years of age were obtained from eight hospitals in JC. We used generalized additive model to evaluate associations, adjusting for seasonal and temporal trends, temperature, relative humidity, day of the week and age. Additionally, we used lagged models and stratification by seasons.Results. Using zip-code specific exposure, we found statistically significant positive associations between PM10 and all RDs (RR, 1.003; 95%CI, 1.002 - 1.003), URI (RR, 1.002; 95%CI, 1.001 - 1.003) and asthma (RR, 1.005; 95%CI, 1.004 - 1.006), and between PM2.5 and all RDs (RR, 1.002; 95% CI, 1.001 - 1.003), URI (RR, 1.001; 95%CI, 1.000 - 1.003), and asthma (RR, 1.003; 95%CI, 1.002 - 1.005). Similarly, significant positive association was noted for speciated pollutants, CO, EC, MMO, NH4 NO3, OC, SO2, SO4, and TC pollutants and RDs, URI and asthma. Inconsistent associations were noted between ozone and all RDs. In lagged analyses, 0-2 days, 0-5 days, and 0-8 days moving-average lagged exposure had stronger association with disease outcomes compared to same day and single-day lagged exposure. No associations were noted between county-wide average PM2.5, PM10, and ozone, and RDs.Conclusion. Our results suggest that short-term exposures to PM and speciated pollutants may account for increased risk of paediatric ED visits for RDs. It may be optimal to characterize personal exposure within small units such as zip-codes compared to county-wide exposures.

Introduction Use of solid fuel for cooking is a major source of household air pollution in developing countries. Of the many pollutants emitted during solid fuel combustion, Particulate Matter (PM)is considered to be one of the most hazardous pollutants. We monitored PM fractions emitted during solid fuel and Liquefied Petroleum Gas(LPG) combustion in kitchens of Sri Lankan households.Methods Households of children in a longitudinal study in Ragama, Sri Lanka was the study population. At the age of 36 months of children, a sample of households were visited and different aerodynamic diameters of PM (PM1, PM2.5, PM10) were monitored during the main cooking session for 3 hours. Basic characteristics of kitchen (e.g., availability of chimney, functionality of chimney, etc.) were assessed by a questionnaire. Cooking energy, other sources of household air pollution, size of open spaces in the kitchen (e.g., windows), etc. were assessed at the time of PM monitoring.Results Questionnaire was administered for mothers in 426 households. Out of them, 245 (57.5%)and 116 (27.2%) households used LPG and wood as the primary cooking fuel respectively. During the cooking period, PM2.5 concentrations of households uses only wood fuel and cook inside the main housing building were 344.1 μg/m3(Inter Quartile Range(IQR) = 173.2-878.0μg/m3), 88.7 μg/m3(54.8- 179.2 μg/m3); 91.7 μg/m3 (56.0- 184.9 μg/m3) and 115.1 μg/m3(83.4 - 247.9 μg/m3) in kitchen, sleeping room, living room and immediate outdoor respectively. Immediate outdoor PM2.5 concentrations in wood burning households was higher among households not having chimney (n = 8)compare to those having a chimney (n = 8) (245.9μg/m3 (IQR = 72.5 – 641.7μg/m3)) VS. (105.7μg/m3 (83.4– 195.8μg/m3)).Fuel type and stove type, availability of a chimney and their functional status, ratio between open space and total space of kitchen, PM2.5 concentration at the non-cooking time (i.e., baseline PM2.5concentration) were the determinants of PM2.5 in wood using kitchens during cooking period.Conclusions PM concentrations were higher in kitchen and other microenvironments of the households use wood for cooking as compared to LPG use for cooking. Immediate outdoor PM concentration was higher than the sleeping and living room PM concentrations. Several factors determine the PM2.5concentrationsduring the cooking including the fuel type.