Title: Poverty, Energy Use, Air Pollution and Health in Ghana
Description: Some of the major themes that characterize the relationship between the environment and population health in the developing world today include poverty, household access to clean cooking fuel, air pollution, sanitation, and infant/child and maternal health. My dissertation research incorporates some of these themes at the interface of community and household energy in the context of economic development in Ghana. Specifically, my dissertation focuses on features of household energy and poverty in both rural and urban areas, as well as air pollution, and child and maternal health in growing urban areas in what is a data and resource-poor setting of Sub‐Saharan Africa (SSA).

Child mortality is declining in most countries. Very few studies have measured child mortality at fine spatial resolutions, which is relevant for assessing community determinants and interventions. The first paper evaluates subnational inequalities in child mortality and its social and environmental determinants in Ghana by applying Bayesian spatial model to Ghana’s 2000 and 2010 National Population and Housing Censuses in 2000 and 2010. The census data were also used to estimate the distributions of households or persons in each of Ghana’s 110 districts for fuel used for cooking, sanitation facility, drinking water source, and maternal and paternal educations. Median district 5q0 declined from 99 deaths per 1,000 live births in 2000 to 70 in 2010. The decline ranged between <5% in some northern districts, where under-five mortality had been higher in 2000, to >40% in southern districts, where it had been lower in 2000, leading to higher inequalities. Primary education increased in men and women and more households had access to improved water and sanitation and cleaner cooking fuels over the same period. Higher use of liquefied petroleum gas for cooking was associated with lower 5q0 in multivariate analysis. Associations for the other social and environmental variables were not consistent or were weak in the different analyses although there were indications of beneficial effects from replacing wood with charcoal or kerosene, from improved sanitation (but not water), and from higher share of mothers and fathers with primary education.

The second paper examines personal particulate matter exposures and locations of 56 students from eight schools in four neighborhoods in of varying socioeconomic status in Accra, Ghana, using gravimetric and continuous PM2.5 data, with time-matched global positioning system coordinates. Personal PM2.5 exposures ranged from less than 10 μg/m3 to more than 150 μg/m3 (mean 56 μg/m3). Girls had higher exposure than boys (67 vs. 44 μg/m3; p-value = 0.001). Exposure was inversely associated with distance of home or school to main roads, but the associations were not statistically significant in the multivariate model. Use of biomass fuels in the area where the school was located was also associated with higher exposure, as was household’s own biomass use. Paved schoolyard surface was associated with lower exposure. School locations in relation to major roads, materials of school ground surfaces, and biomass use in the area around schools may be important determinants of air pollution exposure.

The third paper assesses the feasibility of using hospital administrative records for understanding air pollution health effects on pregnancy outcomes in Accra. This evaluation addresses whether: (i) the available health administrative data can be used to assess PM pollution-related adverse pregnancy outcomes, in particular birth weight; (ii) the health administrative structure and data can be used in the design of follow-up studies in such settings; (iii) the number of births that occur in the city would provide a large enough sample size; and (iv) birth weight distribution in such complex source-pollution environments varies substantially across neighhorhoods. There are six health districts in the Accra metropolis. In addition to other government and private facilities, each district is served by a Government polyclinic, where maternal and child health records in the district are collated. Neonatal and maternal health records, including anthropometric and demographic information are primarily kept by the individual women in cards provided by the Ghana Health Services. There are an estimated 10,000 births annually in each district. The average birth weight across selected facilities was 3,167±458 g, with individual birth weights ranging from 1,200 g to 6,000 g. Mean birth weight was similar across polyclinics. More than 95% of expectant mothers received at least 4 antenatal care visits at a health facility. Child immunization for the full range of vaccines covers over 80% of children born in the metropolis. A retrospective study of the association of air pollution exposure and birth weight in Accra through the use of hospital administrative records is feasible provided mothers are targeted through the public health units, which is responsible for child immunization.