Association between household air pollution and nasopharyngeal pneumococcal carriage in Malawian infants (MSCAPE): a nested, prospective, observational study

Authors: Mukesh Dherani, Daniel Pope, Terence Tafatatha, Ellen Heinsbroek, Ryan Chartier, Thandie S. Mwalukomo, Amelia C. Crampin, Elena Mitsi, Esther L. German, Elissavet Nikolaou, Carla Solórzano, Daniela M. Ferreira, Todd D. Swarthout, Jason Hinds, Kevin Mortimer, Stephen B. Gordon, Neil French, Nigel Bruce - The Lancet 2022 cited by 33

BACKGROUND: Household air pollution from solid fuels increases the risk of childhood pneumonia. Nasopharyngeal carriage of Streptococcus pneumoniae is a necessary step in the development of pneumococcal pneumonia. We aimed to assess the association between exposure to household air pollution and the prevalence and density of S pneumoniae carriage among children. METHODS: (adjusted exposure-response analysis) on the prevalence of S pneumoniae carriage were also assessed in the study children. FINDINGS: was found to significantly increase the risk of S pneumoniae carriage by 10% (1·10 [1·01-1·20]; p=0·035), after adjustment for age, sex, 13-valent pneumococcal conjugate vaccination status, season, current use of antibiotics, and MicroPEM run-time. INTERPRETATION: Despite the absence of effect from the intervention cookstove, household air pollution exposure was significantly associated with the prevalence of nasopharyngeal S pneumoniae carriage. These results provide empirical evidence for the potential mechanistic association between exposure to household air pollution and childhood pneumonia. FUNDING: Bill & Melinda Gates Foundation.