Smoke exposure, hemoglobin levels and the prevalence of anemia: a cross-sectional study in urban informal settlement in Southern Ghana
Date
2024
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Public Health
Abstract
Background In sub-Saharan African cities, more than half of the population lives in informal settlements. These
settlements are close to smoky dumpsites, industrial plants, and polluted roads. Furthermore, polluting fuels remain
their primary sources of energy for cooking and heating. Despite evidence linking smoke and its components to
anaemia, none of these studies were conducted on populations living in urban informal settlements. This study
investigated the risks of anemia/mean Haemoglobin (HB) levels in an informal settlement in Accra, Ghana. Exposure
to smoke was examined across various sources, encompassing residences, neighborhoods, and workplaces.
Methods The study was a facility-based cross-sectional design among residents at Chorkor, an informal settlement
in the Greater Accra region of Ghana. A questionnaire was administered at a community hospital during an interview
to gather data on sources of smoke exposure in the household, in the neighbourhood, and in the workplace. A
phlebotomist collected blood samples from the participants after the interview to assess their anaemia status.
Results The population (n = 320) had a high prevalence of anemia, with 49.1% of people fitting the WHO’s definition
of anemia, while the average HB level was 12.6 ± 2.1 g/dL. Anemia was associated with the number of different types
of waste burnt simultaneously [(1 or 2: prevalence ratio (PR): 95% confidence interval (CI), 1.14, 0.99–1.28: 3+: 1.16,
1.01–1.63, p-for-trend = 0.0082)], fuel stacking [(mixed stacking: 1.27, 1.07–1.20: dirty stacking:1.65, 1.19–2.25, p-fortrend
= 0.0062)], and involvement in fish smoking (1.22, 0.99–1.06). However, the lower limit of the CIs for number of
different forms of garbage burned simultaneously and engagement in fish smoking included unity. Reduced mean
HB levels were associated with the number of different types of waste burnt simultaneously [(1 or 2: regression
coefficient (β): 95% confidence interval (CI), -0.01, -0.97- -0.99: 3+: -0.14, -0.77- -0.05)], current smoker [(yes, almost
daily: -1.40, -2.01- -0.79: yes, at least once a month: -1.14, -1.79- -0.48)], Second-Hand-Smoking (SHS) (yes, almost
daily: -0.77, -1.30- -0.21), fuel stacking [(mixed stacking-0.93, -1.33–0.21: dirty stacking-1.04, -1.60- -0.48)], any smoke exposure indicator in the neighbourhood (-0.84, -1.43- -0.25), living close to a major road (-0.62, -1.09- -0.49), and fish
smoking (-0.41,-0.93- -0.12).
Conclusion Although the cross-sectional design precludes causality, smoke exposure was associated with mean HB
levels and anaemia among populations living in informal settlements.
Description
Research Article
Keywords
Anemia, Ambient air pollution, Informal settlement