Domestic fuel use contributes significantly to household air pollution levels and to the disease burden in low-income households in South Africa. The link between residential fuel stacking and switching, and respiratory health, mediated by household air pollution, remains underexplored, posing challenges to transition to cleaner fuels. This study identified socio-economic determinants of fuel use patterns in two low-income communities of KwaZamokuhle and eMzinoni in South Africa. It also examined the impacts of these patterns on household air pollution levels and respiratory health outcomes. Over half of households relied on dirty fuels across all needs. Average household PM2.5 levels exceeded national daily standards (40 mu g/m(3)). Education level and employment status were significant factors in determining fuel choice, with employed participants less likely to rely on dirty fuels. Town-specific characteristics also influenced household fuel use patterns. In terms of health, 9.5 % of participants had obstructive airways disease and 26.9 % tested positive for inhalant allergens. Heating fuels were strongest predictor of obstructive airways disease (>75 %) whereas cooking fuels were the main predictor of allergen sensitivity (similar to 75 %). The stepwise introduction of cleaner fuels predicted better respiratory health outcomes. The findings of this study suggest that even the partial adoption of cleaner fuels has health benefits and supports the formulation of context-specific mitigation efforts aiming to address negative health effects associated with household air pollution.

Despite the health outcomes associated with exposure to indoor microbial aerosols, the environmental factors contributing to indoor microbial proliferation in residential environments have not been extensively investigated. This study assessed factors associated with indoor bacterial and fungal aerosols in residential apartments within Ibadan, Nigeria. A 12-month survey on housing characteristics and estimation of indoor bacterial and fungal aerosols was carried out in a sample of 356 residential apartments in Ibadan using a standardized home walkthrough checklist and an indoor sampling method. Indoor levels of microbial concentration, total bacterial count, total fungal count, richness ( R ) and Simpson diversity ( D ) were assessed and categorized as either high (>median) or low (≤median) exposures. The results showed that occupant density (adjusted odds ratio (aOR) = 1.03, 95% confidence interval (CI) = 1.01–1.05; aOR = 1.04, 95%CI = 1.02–1.06; aOR = 1.04, 95%CI = 1.02–1.06), leaking roofs (aOR = 2.51, 95%CI = 1.52–4.27; aOR = 1.79, 95%CI = 1.13–2.88; aOR = 1.85, 95%CI = 1.17–2.97) and visible dampness (aOR = 4.67, 95%CI = 2.21–10.34; aOR = 4.37, 95%CI = 2.22–8.81; aOR = 4.28, 95%CI = 2.17–8.59) were independently associated with higher levels of bacterial concentrations, richness and diversity respectively. Culturally relevant interventions targeted at these factors would be promising in managing microbial proliferation in residential environments.

Asthma is a major public health burden worldwide and presents as a health service challenge in low-income countries with poor living conditions and limited access to healthcare services. To assess the relationship between asthma symptom scores, doctor-diagnosed current asthma (DDCA), fractional exhaled nitric oxide (FeNO) levels, and spirometry measurements as methods for assessing the respiratory health of adult women in rural and urban households in Zimbabwe. Using a cross sectional study design, 790 adult women were recruited for the Household Air Pollution (HAP) and Lung Health study between March 2018 and December 2019 in Goromonzi and Harare communities in Zimbabwe. Using a validated interviewer-administered respiratory health questionnaire, we created the asthma symptom score with a cut-off point of ≥ 2 ( 0-1 implying none to modest symptoms and ≥ 2 suggesting moderate to severe symptoms) and DDCA categories based on responses to asthma related questions. Spirometry (n = 584) and FeNO (n = 258) measurements were performed, using standard validated techniques. Associations between spirometry z-scores, FeNO, asthma symptom score and the DDCA were analysed. The 790 participants had an average age of 47.5 years (SD = 16.2). Asthma symptom score ≥ 2 was significantly associated with FeNO ≥ 50 ppb (p-value = 0.039) and the obstructive pattern (p-value = 0.018). Participants with DDCA had significantly increased FeNO (p-value < 0.001), a lower Forced expiratory volume in one second (FEV1) (p-value = 0.028) and significantly reduced ratio of FEV1/ forced vital capacity (FVC) z score values (p-value = 0.020). Abnormal FEV1 z score (p-value = 0.011), and obstructive pattern (p-value = 0.001) were also significantly associated with FeNO ≥ 50 ppb. The results of our investigation indicated that those who with DDCA had significantly increased FeNO, and also DDCA was significantly associated with abnormal FEV1 z score, and obstructive pattern. Thus, using a structured and validated asthma symptoms questionnaire might potentially identify individuals with respiratory health symptoms that may require further respiratory health assessment at health facilities for comprehensive asthma diagnosis.

Introduction: Household air pollution from domestic solid fuel use remains a global public health concern, particularly in low‑income communities. This study assessed associations between household fuel use, indoor air pollution, and respiratory health outcomes in two Mpumalanga communities in South Africa. Methods: A cross‑sectional study was conducted in KwaZamokuhle and eMzinoni between July 2019 and February 2020. Indoor PM2‧5 concentrations were measured using Airmetrics MiniVol samplers and TSI DustTrak II monitors. We carried out household surveys, lung function tests and allergen sensitivity testing and performed multivariable logistic regression to assess associations between indoor pollutant exposure and respiratory health outcomes. Results: Indoor and ambient PM2‧5 concentrations in KwaZamokuhle were more than twice as high as those in eMzinoni, exceeding both national standards and WHO Air Quality Guidelines. Coal use for heating was more prevalent in KwaZamokuhle and appeared directly related to elevated PM2‧5 levels. Approximately 9% of participants exhibited signs of obstructive airway disease, and 25% had positive results for allergen sensitisation. Although the associations between PM2‧5 levels, solid fuel use and measured respiratory outcomes did not reach statistical significance, consistent trends in the expected direction were observed, suggesting a potential relationship that warrants longitudinal studies with larger sample sizes. Conclusion: These findings suggest complex, possibly nonlinear relationships between indoor air pollution and respiratory health effects. The study underscores the urgent need for a greater use of clean energy alternatives and increased public awareness about the risks of household air pollution in low‑income South African communities.

The quality of life for cervical cancer patients is often severely impacted by both the physical and emotional burdens of the disease, including pain, fatigue, and psychological distress. Treatment side effects and the long-term challenges of managing cancer also contribute to diminished well-being, affecting daily activities, social relationships, and mental health. The purpose of this study was to assess the quality of life of patients diagnosed with cervical cancer in a resource-limited setting in South Africa. This study examined the quality of life (QOL) among female patients diagnosed with cervical cancer in the past year, using an electronic WHO Quality of Life (WHOQOL) assessment in the Zululand district, KwaZulu-Natal. The patient navigators used tablets to collect the data on REDCap. Participants (n=35), aged between 34 and 72 years, were surveyed across four hospitals and clinics in KwaZulu-Natal, South Africa. The majority (94.3%) were first-time participants, with 63.6% being unemployed and 72.7% reporting single marital status. Educational levels varied, with high school being the most common. The WHOQOL tool evaluated QOL across four domains: Physical, Psychological, Social Relationships, and Environment. Over half of the patients rated their overall quality of life as “neither good nor poor”. Notably, 42.9% reported experiencing severe pain that interfered with daily activities, and an equal percentage expressed a high dependency on medical treatments to function effectively. Additionally, 34.3% of participants were dissatisfied with their health, while 20% reported some level of satisfaction. Domain-specific scores indicated substantial challenges in the Physical and Psychological domains, with lower scores reflecting issues such as limited energy, pain, and emotional difficulties. However, scores in the Social Relationships and Environmental domains were relatively higher, suggesting a satisfactory level of support from family and friends and moderate satisfaction with their living conditions. This analysis underscores the significant physical and psychological burdens faced by cervical cancer patients, calling attention to the importance of integrated health services that address pain management, mental health, and social support. The treatment of cervical cancer patients should also focus on improving the Quality of Life in this group of patients by targeting holistic care approaches. Siyabonga B. Dlamini, Nocawe Ndukula, Nkosana Jafta, Themba G. Ginindza. Quality of Life Scores of Women Diagnosed with Cervical Cancer in the Zululand District, Kwazulu- Natal [abstract]. In: Proceedings of the 13th Annual Symposium on Global Cancer Research; 2025 Sep 16. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(12_Suppl):Abstract nr 75.

Metal constituents in indoor particulate matter (PM) emitted by household materials and indoor activities present an environmental challenge globally. This study investigated the variation of metal constituent concentrations in indoor PM collected from different communities and the association of metals with household characteristics and indoor occupant activities. PM2.5 and PM10 samples collected on Teflon filters during the field studies in the south and north Durban and Highveld region of South Africa were analysed for metal constituents by digesting in nitric acid and hydrochloric acid solution (aqua regia). These samples were analysed for metals using inductively coupled plasma-optical emission spectrometry (ICP-OES). Standardised interviews and structured household walkthrough assessments that were conducted provided additional covariates. Multivariate linear regression models were developed using factors from the factor analysis, and variables identified in the bivariate analysis. The decreasing order of metal content in PM2.5 was as follows: Fe > Cr > Cu > Mn > Al > Hg > Zn > As > Cd > Pb, whereas in PM10 the metal content had the following decreasing order: Fe > Al > As > Cu > Cr > Hg > Zn > Cd > Mn > Pb. Metal concentrations (Cd, Fe, Mn, and Pb) in PM2.5 varied significantly in different geographical locations. Household characteristics including higher household age, presence of a ceiling, and cemented floor type were significantly associated with increased Cr, Fe, and Hg in indoor PM2.5, respectively (p < 0.05). The association of metallic components in indoor PM with household characteristics provides an opportunity to raise issues of deteriorated old households to local authorities and policymakers who need to implement strategies to replace old building materials releasing metal-rich particles.

Cervical cancer is one of the most preventable cancers, yet it remains a leading cause of cancer- related deaths among women, especially in low- and middle-income countries. Screening programs, such as Pap smears and HPV testing, play a crucial role in early detection and significantly reduce the risk of advanced cervical cancer. However, awareness and participation in screening programs vary widely, often hindered by factors like limited healthcare access, cultural barriers, and lack of education on cervical cancer. Increasing awareness and access to screening is essential for reducing cervical cancer incidence and promoting women’s health globally. The purpose of this study was to evaluate the knowledge, attitudes and practices towards cervical cancer screening among women in a resource-limited setting in South Africa. The baseline survey was conducted in the sub-districts of Abaqulusi, eDumbe, uPhongolo, Ulundi and Nongoma targeting community members at 52 healthcare facilities. Each clinic aimed to recruit 50 participants, reaching a total of 26,000 respondents. The survey training for CBO personnel covered research principles, ethics, informed consent, questionnaire content, and recruitment strategies, ensuring accurate and culturally sensitive data collection. The survey results indicate variability in baseline knowledge across facilities, with median knowledge scores ranging from 36.7% to 86.7%, and an overall median of 60%. This variation reflects significant disparities in cervical cancer awareness and screening knowledge, likely influenced by location-specific factors and resource availability. Sub-district analysis showed eDumbe with a mean score of 58.4%, Abaqulusi at 57.1%, and uPhongolo at 55.9%, suggesting a uniform yet limited awareness level across regions. These findings highlight the urgent need for targeted educational interventions to enhance cervical cancer screening awareness, especially in lower-scoring areas. The results of this baseline survey will inform future training efforts, the development of tailored health education materials, and the implementation of screening programs across all sub-districts in the coming year. Such efforts are crucial in building community capacity for early detection and prevention of cervical cancer, ultimately aiming to reduce morbidity and mortality rates within the KwaZulu-Natal region. Siyabonga B. Dlamini, Nocawe Ndukula, Nkosana Jafta, Zamasomi P. B. Luvuno, Gugu Gigaba, Khumbulani W. Hlongwana, Themba G. Ginindza. Baseline Knowledge, Attitudes, and Practices Towards Cervical Cancer Screening Among Women Attending Primary Healthcare Facilities in the Zululand District, South Africa [abstract]. In: Proceedings of the 13th Annual Symposium on Global Cancer Research; 2025 Sep 16. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(12_Suppl):Abstract nr 74.

Evidence suggests that pollutants like particulate matter and heavy metals significantly impact health. This study investigated the determinants and sources of indoor PM2.5 heavy metals and assessed the health risk to children in Durban. Thirty households of mothers participating in the mother and child in the environment (MACE) birth cohort study were assessed for PM2.5 heavy metals. Multivariate linear regression was used to identify the determinants of PM2.5 heavy metals, while Pearson correlation and principal component analysis identified their sources. The health risk for children was assessed using measured metal concentrations. Proximity to industry, wall type, house age, and presence of windows increased some PM2.5 heavy metals, while cross ventilation reduced indoor PM2.5 As and Cu levels. Pearson correlation and principal component analysis indicated household, traffic, industrial, and natural sources as potential contributors. The health index was greater than 1, and cancer risk values for PM2.5 As and Pb exceeded acceptable levels. The findings highlight the toxicity of indoor air due to heavy metals and the potential for adverse health outcomes in children. To protect vulnerable groups, it is essential to prevent exposure to high-risk metals.

Purpose of review Despite evidence emerging from the Global Burden of Disease studies that biomass use and household air pollution are declining globally, with important positive health impacts for households in low- and middle-income countries, these trends have not been equally documented in African countries. This review describes the state of household air pollution exposure and its relationship with respiratory disease in Africa. Recent findings African studies on this topic are limited, and generally focus on respiratory infections. Most evidence emerge from models based on the Global Burden of Disease data, and from limited individual epidemiological studies across the continent. More than 80% of the African population is exposed to household air pollution. Women and children continue to bear the substantial burden of exposure. Evidence from limited exposure-response studies strongly points to household air pollution being the major driver of acute and chronic respiratory diseases on the continent. Summary Respiratory infections, particularly in children, and other chronic respiratory diseases, are strongly attributable to household air pollution. Elimination of such exposures through interventions such as cleaner fuels and preferably, electricity, is critical to improving respiratory health on the continent.

Southern Africa bears disproportionate consequences of the changing climate. The El Niño Southern Oscillation causes phases of extreme weather events, leading to flooding and extended periods of droughts in different regions of the sub-continent. Our data provides evidence that the extreme El Niño event of 2014–16 increased the risk for perinatal infant mortality in the Northern Cape and North West provinces of South Africa. The maternal health services profile of the Northern Cape and KwaZulu-Natal suggests a compromised health system with limited resilience to respond to the climate crises. The National Department of Health lacks adequate policies and strategies to ensure systems are able to meet the maternal and child health requirements in the context of climate change.

BACKGROUND AND AIM: There is growing evidence that, pollutants such as particulate matter and heavy metals are associated with significant health impacts. The aim of this study was to identify the predictors and common sources of indoor PM2.5 heavy metals and evaluate the health risk to the children living in Durban. METHOD: Thirty households belonging to mothers participating in the mother and child in the environment birth cohort study were selected for this study. Airmetrics MiniVol samplers loaded with Teflon membrane filters were used for sampling airborne indoor PM2.5. A wavelength-dispersive x-ray fluorescence technique was used to assess the amount of heavy metals in the filters. Contamination levels were evaluated using contamination factor (CF), enrichment factor (EF), and pollution load index (PLI). Multivariate linear regression models were used to identify the predictors of indoor PM2.5 heavy metals. The common sources of PM2.5 heavy metals were identified using Pearson correlation and principal component analysis. The measured concentrations of metals were used to estimate the health risk for children. RESULTS: According to CF, EF and PLI contamination exist in the assessed homes. Proximity to industry, wall type, age of the house, presence of windows, and proximity to pollution generating activities were associated with an increase in the levels of some indoor PM2.5 heavy metals. Cross ventilation was associated with a reduction in indoor PM2.5 As and Cu levels. The use of Pearson correlation and principal component analysis point to the potential roles of household characteristics, traffic emissions, industries, and natural sources. The health index was 1, and the cancer risk values in PM2.5 As and Pb exceeded the maximum acceptable level of carcinogenic risk for humans. CONCLUSIONS: This study highlights the potential contribution of heavy metals to indoor PM2.5 toxicity. To protect vulnerable groups from exposure to heavy metals, it is necessary to prevent exposure to high-risk metals.

Residential microbial composition likely contributes to the development of lower respiratory tract infections (LRTI) among children, but the association is poorly understood. We aimed to study the relationship between the indoor airborne dust bacterial and fungal microbiota and childhood LRTI in Ibadan, Nigeria. Ninety-eight children under the age of five years hospitalized with LRTI were recruited and matched by age (±3 months), sex, and geographical location to 99 community-based controls without LRTI. Participants' homes were visited and sampled over a 14-day period for airborne house dust using electrostatic dustfall collectors (EDC). In airborne dust samples, the composition of bacterial and fungal communities was characterized by a meta-barcoding approach using amplicons targeting simultaneously the bacterial 16S rRNA gene and the internal-transcribed-spacer (ITS) region-1 of fungi in association with the SILVA and UNITE database respectively. A 100-unit change in house dust bacterial, but not fungal, richness (OR 1.06; 95%CI 1.03-1.10) and a 1-unit change in Shannon diversity (OR 1.92; 95%CI 1.28-3.01) were both independently associated with childhood LRTI after adjusting for other indoor environmental risk factors. Beta-diversity analysis showed that bacterial (PERMANOVA p < 0.001, R2 = 0.036) and fungal (PERMANOVA p < 0.001, R2 = 0.028) community composition differed significantly between homes of cases and controls. Pair-wise differential abundance analysis using both DESEq2 and MaAsLin2 consistently identified the bacterial phyla Deinococcota (Benjamini-Hochberg (BH) adjusted p-value <0.001) and Bacteriodota (BH-adjusted p-value = 0.004) to be negatively associated with LRTI. Within the fungal microbiota, phylum Ascomycota abundance (BH adjusted p-value <0.001) was observed to be directly associated with LRTI, while Basidiomycota abundance (BH adjusted p-value <0.001) was negatively associated with LRTI. Our study suggests that early-life exposure to certain airborne bacterial and fungal communities is associated with LRTI among children under the age of five years.

Background: Previous epidemiological studies demonstrated an increased risk of respiratory health effects in children and adults exposed to dampness or mold. This study investigated associations of quantitative indicators of indoor dampness and mold exposure with severe lower respiratory tract infections (LRTI) among children aged 1–59 months in Ibadan, Nigeria. Methods: In-home visits were conducted among 178 children hospitalized with LRTI matched by age (±3 months), sex, and geographical location with 180 community-based children without LRTI. Trained study staff evaluated the indoor environment using a standardized home walkthrough checklist and measured visible dampness and mold damage. Damp-moldy Index (DMI) was also estimated to quantify the level of exposure. Exposure-response relationships of dampness and mold exposure with severe LRTI were assessed using multivariable restricted cubic spline regression models adjusting for relevant child, housing, and environmental characteristics. Results: Severe LRTI cases were more often male than female (61.8%), and the overall mean (SD) age was 7.3 (1.35) months. Children exposed to dampness <0.3 m 2 (odds ratio [OR] = 2.11; 95% confidence interval [CI] = 1.05, 4.36), and between 0.3 and 1.0 m 2 (OR = 2.34; 95% CI = 1.01, 7.32), had a higher odds of severe LRTI compared with children not exposed to dampness. The restricted cubic spline showed a linear exposure-response association between severe LRTI and residential dampness ( P < 0.001) but a nonlinear relationship with DMI ( P = 0.01). Conclusions: Residential dampness and DMI were exposure-dependently associated with higher odds of severe LRTI among under-five children. If observed relationships were causal, public health intervention strategies targeted at reducing residential dampness are critically important to mitigate the burden of severe LRTI among under-five children.

Introduction Quality assessment is a critical component of determining the value of medical services, including palliative care. The utilisation of palliative care quality measures could assist in assessing the degree to which patients living with cancer conform to best practice of palliative care, identifying gaps and monitoring changes in cancer care delivery models in different setting. This scoping review aims to map the available data on the usage of palliative care quality indicators that are relevant to cancer patients in low- and middle-income countries (LMICs). Methods To structure this study, we will use the framework developed by Arksey and O’Malley, the Levac et al. recommendations and the Joanna Briggs Institute recommendations. We will search EBSCOHost, Web of Science, ProQuest One Academic, MEDLINE and Google Scholar for evidence on palliative care quality measures applicable for patients living with cancer published from inception till 2022. We will search grey literature in the form of dissertations, conference proceedings and websites of international organisations such as the World Health Organisation (WHO) reporting palliative care quality measures applicable to patients living with cancer in LMICs. Discussion The purpose of this study is to establish the extent of existing research on the palliative care quality measures in LMICs. Although palliative care is still a new phenomenon, understanding of the palliative care quality measures applicable for cancer patients will assist to improve care across all components of health systems. Ethics and dissemination No ethical approval is required for the study as the data collection and results of the proposed scoping review will be conducted and disseminated electronically using peer-reviewed journals, print and presentations at scientific conferences and stakeholder presentations.

Household air pollution (HAP) from biomass fuels significantly contributes to cardio-respiratory morbidity and premature mortality globally. Particulate matter (PM), one of the pollutants generated, remains the most accurate indicator of household air pollution. Determining indoor air concentration levels and factors influencing these levels at the household level is of prime importance, as it objectively guides efforts to reduce household air pollution. This paper describes household factors associated with increased PM2.5 levels in Zimbabwean rural household kitchens. Our HAP and lung health in women study enrolled 790 women in rural and urban households in Zimbabwe between March 2018 and December 2019. Here, we report data from 148 rural households using solid fuel as the primary source of fuel for cooking and heating and where indoor air samples were collected. Data on kitchen characteristics and practices were collected cross-sectionally using an indoor walk-through survey and a modified interviewer-administered questionnaire. An Air metrics miniVol Sampler was utilized to collect PM2.5 samples from the 148 kitchens over a 24 h period. To identify the kitchen features and practices that would likely influence PM2.5 concentration levels, we applied a multiple linear regression model. The measured PM2.5 ranged from 1.35 μg/m3 to 1940 μg/m3 (IQR: 52.1–472). The PM2.5 concentration levels in traditional kitchens significantly varied from the townhouse type kitchens, with the median for each kitchen being 291.7 μg/m3 (IQR: 97.2–472.2) and 1.35 μg/m3 (IQR: 1.3–97.2), respectively. The use of wood mixed with other forms of biomass was found to have a statistically significant association (p < 0.001) with increased levels of PM2.5 concentration. In addition, cooking indoors was strongly associated with higher PM2.5 concentrations (p = 0.012). Presence of smoke deposits on walls and roofs of the kitchens was significantly associated with increased PM2.5 concentration levels (p = 0.044). The study found that kitchen type, energy type, cooking place, and smoke deposits were significant predictors of increased PM2.5 concentrations in the rural households. Concentrations of PM2.5 were high as compared to WHO recommended exposure limits for PM2.5. Our findings highlight the importance of addressing kitchen characteristics and practices associated with elevated PM2.5 concentrations in settings where resources are limited and switching to cleaner fuels may not be an immediate feasible option.

Abstract Background This study aimed to investigate the association between exposure to diverse indoor microbial aerosols and lower respiratory tract infections (LRTI) among children aged 1 to 59 months in Ibadan, Nigeria. Methods One hundred and seventy-eight (178) hospital-based LRTI cases among under-five children were matched for age (± 3 months), sex and geographical location with 180 community-based controls (under-five children without LRTI). Following consent from caregivers of eligible participants, a child’s health questionnaire, clinical proforma and standardized home-walkthrough checklist were used to collect data. Participant homes were visited and sampled for indoor microbial exposures using active sampling approach by Anderson sampler. Indoor microbial count (IMC), total bacterial count (TBC), and total fungal count (TFC) were estimated and dichotomized into high (> median) and low (≤ median) exposures. Alpha diversity measures including richness (R), Shannon (H) and Simpson (D) indices were also estimated. Conditional logistic regression models were used to test association between exposure to indoor microbial aerosols and LRTI risk among under-five children. Results Significantly higher bacterial and fungal diversities were found in homes of cases (R = 3.00; H = 1.04; D = 2.67 and R = 2.56; H = 0.82; D = 2.33) than homes of controls (R = 2.00; H = 0.64; D = 1.80 and R = 1.89; H = 0.55; D = 1.88) p < 0.001, respectively. In the multivariate models, higher categories of exposure to IMC (aOR = 2.67, 95% CI 1.44–4.97), TBC (aOR = 2.51, 95% CI 1.36–4.65), TFC (aOR = 2.75, 95% CI 1.54–4.89), bacterial diversity (aOR = 1.87, 95% CI 1.08–3.24) and fungal diversity (aOR = 3.00, 95% CI 1.55–5.79) were independently associated with LRTI risk among under-five children. Conclusions This study suggests an increased risk of LRTI when children under the age of five years are exposed to high levels of indoor microbial aerosols.

The association between in utero exposure to indoor PM2.5 and birth outcomes is not conclusive. We assessed the association between in utero exposure to indoor PM2.5 , birth weight, gestational age, low birth weight, and/or preterm delivery. Homes of 800 pregnant women were assessed using a structured walkthrough questionnaire. PM2.5 measurements were undertaken in 300 of the 800 homes for a period of 24 h. Repeated sampling was conducted in 30 of these homes to determine PM2.5 predictors that can reduce within-and/or between-home variability. A predictive model was used to estimate PM2.5 levels in unmeasured homes (n = 500). The mean (SD) for PM2.5 was 37 µg/m3 (29) with a median of 28µg/m3 . The relationship between PM2.5 exposure, birth weight, gestational age, low birth weight, and preterm delivery was assessed using multivariate linear and logistic regression models. We explored infant sex as a potential effect modifier, by creating an interaction term between PM2.5 and infant sex. The odds ratio of low birth weight and preterm delivery was 1.75 (95%CI: 1.47, 2.09) and 1.21 (95%CI: 1.06, 1.39), respectively, per interquartile increase (18 µg/m3 ) in PM2.5 exposure. The reduction in birth weight and gestational age was 75 g (95%CI: 107.89, 53.15) and 0.29 weeks (95%CI: 0.40, 0.19) per interquartile increase in PM2.5 exposure. Infant sex was an effect modifier for PM2.5 on birth weight and gestational age, and the reduction in birth weight and gestational age was 103 g (95%CI: 142.98, 64.40) and 0.38 weeks (95% CI: 0.53, 0.23), respectively, for boys, and 54 g (95%CI: 91.78,15.62) and 0.23 weeks (95%CI:0.37, 0.08), respectively, for girls. Exposure to PM2.5 is associated with adverse pregnancy outcomes. To protect the population during their reproductive period, public health policy should focus on indoor PM2.5 levels.

Introduction: Globally, chronic lung diseases are responsible for approximately 4 million premature deaths annually. Spirometry is one of the methods used in the diagnosis and management of chronic lung diseases. The Global Lung Initiative of 2012 managed to develop multi ethnic spirometry equations for use across all age groups. Since their publication, several validation studies have done to establish their suitability with the various ethnicities. To date no study has been done in Zimbabwe to validate the GLI 2012 among adult women. The study aimed to validate the GLI 2012 African -American module in adult Zimbabwean women. Methods: A total of 566 healthy, non-smoking adult women from urban and peri-urban households in Zimbabwe were recruited over period of 18 months. Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV 1), and the ratio of FEV1 to FVC were measured according to the American Thoracic Society and European Respiratory Society Guidelines. Results: The findings from the study supports the use of GLI 2012 African -American module in adult Zimbabweans (mean for FVC, FEV1 and ratio is within ±0.5). Also, the analysis of relationships between anthropometry and African-American GLI2012 SRE z-scores showed weak correlations between ±0.14. Weak correlations provide no evidence of bias in the generation of spirometry z-scores in this population. Conclusion: The African-American GLI2012 SRE predict the lung function capacities in adult Zimbabwean women.

Background: The increasing cancer burden remains a public health challenge. Quality and accurate population data is important to improve cancer control, screening, and treatment programmes for the sub-Saharan Africa region. Aim: The aim of this study was to establish hospital-based cancer surveillance system, thereby reporting the burden that cancer diagnosis and treatment place on 3 hospitals – an approach of health systems strengthening. Methods: A hospital-based cancer surveillance was established in 3 public health facilities that provide oncology services in KwaZulu-Natal. An active method was used for finding cancer cases. The cancer surveillance database was evaluated according to the criteria recommended for cancer registries. Analyses of data included descriptive and crude incidence rates. Results: A total of 2307 newly diagnosed cancer cases were reported in 2018, with a majority from Inkosi Albert Luthuli Central hospital (65.3%), followed by Greys hospital (30.8%) and then Addington hospital (3.94%). Most of the cancer cases were from the 2 major urban areas of the province (eThekwini and uMgungundlovu district). The most commonly diagnosed cancers from all combined 3 facilities for both sexes were breast, cervix, colorectal, Kaposi Sarcoma, and lung. Approximately half of the cancer cases had no staging, and 12.8% of the cases were diagnosed at stage 4. The mostly prescribed treatments for the patients were radiotherapy and chemotherapy. Conclusions: Based on our hospital-based surveillance, cancer burden is high in the 3 facilities. Strengthening cancer screening and diagnostic policies and procedures that will allow expansion of accurate cancer surveillance system is essential in KwaZulu-Natal and South Africa as a whole.

Background Despite the recognition of the importance of indoor microbial exposures on children’s health, the role of different microbial agents in development and aggravation of respiratory symptoms and diseases is only poorly understood. This study aimed to assess whether exposure to microbial aerosols within the indoor environment are associated with respiratory symptoms among children under-5 years of age. Methods A systematic literature search was conducted on PubMed, Web of Science, GreenFILE, ScienceDirect, EMBASE and Cochrane library through February 2020. Studies that investigated the exposure–response relationship between components of the indoor microbial communities and respiratory symptoms among under-five children were eligible for inclusion. A random-effect meta-analysis was applied to estimate pooled relative risk (RR) and 95% confidence interval (CI) for study specific high versus low microbial exposures. The potential effect of individual studies on the overall estimate was evaluated using leave-one-out analysis, while heterogeneity was evaluated by I 2 statistics using RevMan 5.3. Results Fifteen studies were eligible for inclusion in a meta-analysis. The pooled risk estimate suggested that increased microbial exposure was associated with an increased risk of respiratory symptoms [pooled relative risk (RR): 1.24 (1.09, 1.41), P = 0.001]. The association was strongest with exposure to a combination of Aspergillus , Penicillium, Cladosporium and Alternaria species [pooled RR: 1.73 (1.30, 2.31), P = 0.0002]. Stratified analysis revealed an increased risk of wheeze [pooled RR: 1.20 (1.05, 1.37), P = 0.007 and allergic rhinitis [RR: 1.18 (0.94, 1.98), P = 0.16] from any microbial exposure. Conclusions Microbial exposures are, in general, associated with risk of respiratory symptoms. Future studies are needed to study the indoor microbiome more comprehensively, and to investigate the mechanism of these associations.