Digital Auscultation and Pulmonary Function Testing Among Rural Bangladeshi Infants

孟加拉国农村婴儿的数字听诊和肺功能测试

• 批准号: 9922276
• 负责人: Eric Douglass McCollum
• 金额: $ 9.24万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9922276
• 关键词: 5 year old; Acute; Affect; Age; Age-Months; Agreement; Air Pollution; American; Area; Asthma; Auscultation; Bangladesh; Bangladeshi; Biomass; Birth; Breathing; Caliber; Caring; Cause of Death; Cessation of life; Chest; Child; Child Health; Childhood; Childhood Asthma; Chronic; Chronic lung disease; Clinical; Clinical Research; Cohort Studies; Communities; Community Health Aides; Complex; Computer Analysis; Cookstove; Crackles; Data; Diagnosis; Diagnostic; Dose; Effectiveness; European; Exhalation; Exploratory/Developmental Grant for Diagnostic Cancer Imaging; Exposure to; Future; Gases; Goals; Health; Health Benefit; Heating; Hospitals; Hour; Household; Household Air Pollution; Human; Incidence; Infant; International; Intervention; Laboratories; Lighting; Literature; Longitudinal cohort; Lung; Lung diseases; Measurement; Methodology; Methods; National Institute of Environmental Health Sciences; Nitric Oxide; Outcome; Particulate Matter; Pneumonia; Population; Pregnant Women; Prevalence; Pulmonary function tests; Reference Values; Research; Resources; Respiratory Sounds; Respiratory physiology; Risk; Rural; Rural Community; Rural Health; Sleep; Smoke; Societies; Source; Stethoscopes; Techniques; Translational Research; Uncertainty; Validation; Wheezing; Woman; World Health Organization; airway inflammation; base; biomass fuel; burden of illness; cohort; computerized; cooking; diagnostic accuracy; digital; experience; improved; indexing; indoor pollutant; infant monitoring; infection risk; innovation; low and middle-income countries; lung injury; mortality; novel; pollutant; premature; prenatal; prenatal exposure; respiratory; respiratory health; response; rural area; sound; stem; 5 year old; Acute; Affect; Age; Age-Months; Agreement; Air Pollution; American; Area; Asthma; Auscultation; Bangladesh; Bangladeshi; Biomass; Birth; Breathing; Caliber; Caring; Cause of Death; Cessation of life; Chest; Child; Child Health; Childhood; Childhood Asthma; Chronic; Chronic lung disease; Clinical; Clinical Research; Cohort Studies; Communities; Community Health Aides; Complex; Computer Analysis; Cookstove; Crackles; Data; Diagnosis; Diagnostic; Dose; Effectiveness; European; Exhalation; Exploratory/Developmental Grant for Diagnostic Cancer Imaging; Exposure to; Future; Gases; Goals; Health; Health Benefit; Heating; Hospitals; Hour; Household; Household Air Pollution; Human; Incidence; Infant; International; Intervention; Laboratories; Lighting; Literature; Longitudinal cohort; Lung; Lung diseases; Measurement; Methodology; Methods; National Institute of Environmental Health Sciences; Nitric Oxide; Outcome; Particulate Matter; Pneumonia; Population; Pregnant Women; Prevalence; Pulmonary function tests; Reference Values; Research; Resources; Respiratory Sounds; Respiratory physiology; Risk; Rural; Rural Community; Rural Health; Sleep; Smoke; Societies; Source; Stethoscopes; Techniques; Translational Research; Uncertainty; Validation; Wheezing; Woman; World Health Organization; airway inflammation; base; biomass fuel; burden of illness; cohort; computerized; cooking; diagnostic accuracy; digital; experience; improved; indexing; indoor pollutant; infant monitoring; infection risk; innovation; low and middle-income countries; lung injury; mortality; novel; pollutant; premature; prenatal; prenatal exposure; respiratory; respiratory health; response; rural area; sound; stem

PROJECT SUMMARY: This is a re-submission for a National Institute of Environmental Health Sciences R21 award aiming to comprehensively evaluate digital auscultation and pulmonary function testing among Bangladeshi infants as innovative respiratory outcomes for future air pollution research in low-middle income countries (LMICs). Household air pollution (HAP) is the number one environmental cause of death worldwide and disproportionally affects the health of rural women and children in LMICs like Bangladesh. Particulate matter with an aerodynamic diameter <2.5 µm (PM2.5) is an important indoor pollutant that is primarily generated by biomass fuel use during cooking, heating, and lighting. Elevated PM2.5 exposure has been associated with a substantially increased risk of child pneumonia mortality, the leading cause of infectious death in children globally, and childhood asthma incidence, the number one chronic lung disease among children worldwide. To date LMIC HAP research aiming to evaluate respiratory outcomes in children associated with PM2.5 exposure has focused on the acute endpoint of World Health Organization-defined pneumonia, a diagnosis known as poorly accurate and highly non-specific for studying pediatric respiratory health effects attributable to HAP. We aim to generate evidence supporting digital auscultation and pulmonary function testing as feasible, innovative, and diagnostically accurate pediatric respiratory health outcomes for inclusion in future LMIC HAP research within the rural communities most affected by HAP. To accomplish this overall goal we will conduct a longitudinal birth cohort study among 400 rural Bangladeshi pregnant women and their infants until the age of two months. For Aim 1 we will systematically evaluate lung sound recording quality by community health workers using a novel digital stethoscope during their care of rural Bangladeshi infants. We hypothesize that >90% of sounds will meet quality criteria, high interpretation agreement will be achieved between human listeners and also between automated computer analysis and humans, and that elevated prenatal PM2.5 concentrations will be associated with a higher incidence of abnormal digitally recorded lung sounds among infants. For Aim 2 we will create population reference values and evaluate the feasibility and validity of non-invasive, unsedated lung function testing of rural Bangladeshi two month old infants. We hypothesize that >90% of measurements will meet international validation criteria, infant lung function testing will be feasible, and that prenatal exposure to elevated PM2.5 concentrations will be associated with lower infant lung function. Successful completion of the research described in this application will dramatically advance the methodology for accurate assessment of acute and chronic child respiratory outcomes for future LMIC HAP research, and can also serve as crosscutting methods suitable for resource-rich settings and non-HAP research in LMICs.

项目摘要： 这是国家环境健康科学研究所R21奖的重新提出，目的是 全面评估孟加拉国婴儿中的数字听觉和肺功能测试 低中型收入国家（LMIC）未来空气污染研究的创新呼吸结果。 家庭空气污染（HAP）是全球死亡的第一大死亡原因，不成比例地 影响孟加拉国等LMIC的农村妇女和儿童的健康。颗粒物与 空气动力学直径<2.5 µm（PM2.5）是一种重要的室内污染物，主要由生物质产生 在烹饪，加热和照明期间使用燃料。升高的PM2.5暴露与 儿童肺炎死亡率的风险大大增加，这是儿童传染性死亡的主要原因 全球和童年哮喘事件，全球儿童中的第一次慢性肺部疾病。到 日期LMIC HAP研究旨在评估与PM2.5暴露有关的儿童的呼吸结局 专注于世界卫生组织定义的肺炎的急性终点，该诊断被称为 对于研究归因于HAP的小儿呼吸健康效应，精确且高度非特异性。 我们旨在生成支持数字听诊和肺功能测试的证据， 创新和诊断准确的小儿呼吸健康结果，以纳入未来的LMIC HAP 在农村社区中受到HAP影响最大的研究。为了实现这一总体目标，我们将进行 400名孟加拉国孕妇及其婴儿的纵向出生队列研究直到年龄 两个月。对于目标1，我们将系统地评估社区的肺声记录质量 卫生工作者在护理孟加拉国的婴儿期间使用新型的数字听诊器。我们 假设> 90％的声音将符合质量标准，将实现高解释协议 在人类听众之间以及自动化计算机分析与人类之间，这提升了 产前PM2.5浓度将与异常记录的肺部异常入射有关 婴儿的声音。对于AIM 2，我们将创建人口参考值并评估可行性 和非侵入性，未侵入的未侵入性肺功能测试的有效性 婴儿。我们假设> 90％的测量值将符合国际验证标准，婴儿肺 功能测试将是可行的，并且会导致升高的PM2.5浓度的暴露与 婴儿肺功能较低。 成功完成本应用程序中描述的研究将极大地推进方法论 为了准确评估未来LMIC HAP研究的急性和慢性儿童呼吸结果，以及 还可以用作适用于资源丰富的设置和LMIC的非影响研究的横切方法。