The Risk of Orofacial Cleft Lip/Palate Due to Maternal Ambient Air Pollution Exposure: A Call for Further Research in South Africa
Background: Despite being underreported, orofacial cleft lip/palate (CLP) remains in the top five of South Africa’s most common congenital disorders. Maternal air pollution exposure has been associated with CLP in neonates. South Africa has high air pollution levels due to domestic burning practices...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Ubiquity Press
2023-01-01
|
| Series: | Annals of Global Health |
| Subjects: | |
| Online Access: | https://annalsofglobalhealth.org/articles/4007 |
| _version_ | 1811173039183757312 |
|---|---|
| author | Caradee Y. Wright Thandi Kapwata Bianca Wernecke Helen Malherbe Kurt-W Bütow Natasha Naidoo Rebecca M. Garland Anzel de Lange Gareth E. Murray Operation Smile |
| author_facet | Caradee Y. Wright Thandi Kapwata Bianca Wernecke Helen Malherbe Kurt-W Bütow Natasha Naidoo Rebecca M. Garland Anzel de Lange Gareth E. Murray Operation Smile |
| author_sort | Caradee Y. Wright |
| collection | DOAJ |
| description | Background: Despite being underreported, orofacial cleft lip/palate (CLP) remains in the top five of South Africa’s most common congenital disorders. Maternal air pollution exposure has been associated with CLP in neonates. South Africa has high air pollution levels due to domestic burning practices, coal-fired power plants, mining, industry, and traffic pollution, among other sources. We investigated air pollutant levels in geographic locations of CLP cases. Methods: In a retrospective case series study (2006–2020) from a combined dataset by a Gauteng surgeon and South African Operation Smile, the maternal address at pregnancy was obtained for 2,515 CLP cases. Data from the South African Air Quality Information System was used to calculate annual averages of particulate matter (PM) concentrations of particles < 10 µm (PM10) and < 2.5 µm (PM2.5). Correlation analysis determined the relationship between average PM2.5/PM10 concentrations and CLP birth prevalence. Hotspot analysis was done using the Average Nearest Neighbor tool in ArcGIS. Results: Correlation analysis showed an increasing trend of CLP birth prevalence to PM10 (CC = 0.61, 95% CI = 0.38–0.77, p < 0.001) and PM2.5 (CC = 0.63, 95% CI = 0.42–0.77, p < 0.001). Hot spot analysis revealed that areas with higher concentrations of PM10 and PM2.5 had a higher proclivity for maternal residence (z-score = –68.2, p < 0.001). CLP birth prevalence hotspot clusters were identified in district municipalities in the provinces of Gauteng, Limpopo, North-West, Mpumalanga, and Free State. KwaZulu-Natal and Eastern Cape had lower PM;10 and PM2.5 concentrations and were cold spot clusters. Conclusions: Maternal exposure to air pollution is known to impact the fetal environment and increase CLP risk. We discovered enough evidence of an effect to warrant further investigation. We advocate for a concerted effort by the government, physicians, researchers, non-government organizations working with CLP patients, and others to collect quality data on all maternal information and pollutant levels in all provinces of South Africa. Collaboration and data sharing for additional research will help us better understand the impact of air pollution on CLP in South Africa. |
| first_indexed | 2024-04-10T17:41:22Z |
| format | Article |
| id | doaj.art-a82eddd599cb4608873c59dd3cbb05a6 |
| institution | Directory Open Access Journal |
| issn | 2214-9996 |
| language | English |
| last_indexed | 2024-04-10T17:41:22Z |
| publishDate | 2023-01-01 |
| publisher | Ubiquity Press |
| record_format | Article |
| series | Annals of Global Health |
| spelling | doaj.art-a82eddd599cb4608873c59dd3cbb05a62023-02-03T13:58:46ZengUbiquity PressAnnals of Global Health2214-99962023-01-0189110.5334/aogh.40072823The Risk of Orofacial Cleft Lip/Palate Due to Maternal Ambient Air Pollution Exposure: A Call for Further Research in South AfricaCaradee Y. Wright0Thandi Kapwata1Bianca Wernecke2Helen Malherbe3Kurt-W Bütow4Natasha Naidoo5Rebecca M. Garland6Anzel de Lange7Gareth E. Murray8Operation Smile9Environment and Health Research Unit, South African Medical Research Council, Pretoria; Department of Geography, Geoinformatics and Meteorology, University of Pretoria, PretoriaEnvironment and Health Research Unit, South African Medical Research Council, Johannesburg; Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, JohannesburgEnvironment and Health Research Unit, South African Medical Research Council, Johannesburg; Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, JohannesburgRare Diseases South Africa, The Station Bryanston, 63 Peter Place, SandtonDepartment of Maxillo-Facial and Oral Surgery, University of Pretoria, and Life-Wilgers Hospital, PretoriaEnvironment and Health Research Unit, South African Medical Research Council, PretoriaDepartment of Geography, Geoinformatics and Meteorology, University of Pretoria, PretoriaDepartment of Geography and Environmental Studies, University of Limpopo, LimpopoEnvironment and Health Research Unit, South African Medical Research Council, JohannesburgOPERATION SMILE, Building 17, 103–104 Waverley Business Park, 5 Wyecraft Rd. Mowbray, Cape TownBackground: Despite being underreported, orofacial cleft lip/palate (CLP) remains in the top five of South Africa’s most common congenital disorders. Maternal air pollution exposure has been associated with CLP in neonates. South Africa has high air pollution levels due to domestic burning practices, coal-fired power plants, mining, industry, and traffic pollution, among other sources. We investigated air pollutant levels in geographic locations of CLP cases. Methods: In a retrospective case series study (2006–2020) from a combined dataset by a Gauteng surgeon and South African Operation Smile, the maternal address at pregnancy was obtained for 2,515 CLP cases. Data from the South African Air Quality Information System was used to calculate annual averages of particulate matter (PM) concentrations of particles < 10 µm (PM10) and < 2.5 µm (PM2.5). Correlation analysis determined the relationship between average PM2.5/PM10 concentrations and CLP birth prevalence. Hotspot analysis was done using the Average Nearest Neighbor tool in ArcGIS. Results: Correlation analysis showed an increasing trend of CLP birth prevalence to PM10 (CC = 0.61, 95% CI = 0.38–0.77, p < 0.001) and PM2.5 (CC = 0.63, 95% CI = 0.42–0.77, p < 0.001). Hot spot analysis revealed that areas with higher concentrations of PM10 and PM2.5 had a higher proclivity for maternal residence (z-score = –68.2, p < 0.001). CLP birth prevalence hotspot clusters were identified in district municipalities in the provinces of Gauteng, Limpopo, North-West, Mpumalanga, and Free State. KwaZulu-Natal and Eastern Cape had lower PM;10 and PM2.5 concentrations and were cold spot clusters. Conclusions: Maternal exposure to air pollution is known to impact the fetal environment and increase CLP risk. We discovered enough evidence of an effect to warrant further investigation. We advocate for a concerted effort by the government, physicians, researchers, non-government organizations working with CLP patients, and others to collect quality data on all maternal information and pollutant levels in all provinces of South Africa. Collaboration and data sharing for additional research will help us better understand the impact of air pollution on CLP in South Africa.https://annalsofglobalhealth.org/articles/4007air pollutioncongenital disorderbirth defectorofacial cleft lip/palatecraniofacial anomaliesenvironmental healthparticulate matter |
| spellingShingle | Caradee Y. Wright Thandi Kapwata Bianca Wernecke Helen Malherbe Kurt-W Bütow Natasha Naidoo Rebecca M. Garland Anzel de Lange Gareth E. Murray Operation Smile The Risk of Orofacial Cleft Lip/Palate Due to Maternal Ambient Air Pollution Exposure: A Call for Further Research in South Africa Annals of Global Health air pollution congenital disorder birth defect orofacial cleft lip/palate craniofacial anomalies environmental health particulate matter |
| title | The Risk of Orofacial Cleft Lip/Palate Due to Maternal Ambient Air Pollution Exposure: A Call for Further Research in South Africa |
| title_full | The Risk of Orofacial Cleft Lip/Palate Due to Maternal Ambient Air Pollution Exposure: A Call for Further Research in South Africa |
| title_fullStr | The Risk of Orofacial Cleft Lip/Palate Due to Maternal Ambient Air Pollution Exposure: A Call for Further Research in South Africa |
| title_full_unstemmed | The Risk of Orofacial Cleft Lip/Palate Due to Maternal Ambient Air Pollution Exposure: A Call for Further Research in South Africa |
| title_short | The Risk of Orofacial Cleft Lip/Palate Due to Maternal Ambient Air Pollution Exposure: A Call for Further Research in South Africa |
| title_sort | risk of orofacial cleft lip palate due to maternal ambient air pollution exposure a call for further research in south africa |
| topic | air pollution congenital disorder birth defect orofacial cleft lip/palate craniofacial anomalies environmental health particulate matter |
| url | https://annalsofglobalhealth.org/articles/4007 |
| work_keys_str_mv | AT caradeeywright theriskoforofacialcleftlippalateduetomaternalambientairpollutionexposureacallforfurtherresearchinsouthafrica AT thandikapwata theriskoforofacialcleftlippalateduetomaternalambientairpollutionexposureacallforfurtherresearchinsouthafrica AT biancawernecke theriskoforofacialcleftlippalateduetomaternalambientairpollutionexposureacallforfurtherresearchinsouthafrica AT helenmalherbe theriskoforofacialcleftlippalateduetomaternalambientairpollutionexposureacallforfurtherresearchinsouthafrica AT kurtwbutow theriskoforofacialcleftlippalateduetomaternalambientairpollutionexposureacallforfurtherresearchinsouthafrica AT natashanaidoo theriskoforofacialcleftlippalateduetomaternalambientairpollutionexposureacallforfurtherresearchinsouthafrica AT rebeccamgarland theriskoforofacialcleftlippalateduetomaternalambientairpollutionexposureacallforfurtherresearchinsouthafrica AT anzeldelange theriskoforofacialcleftlippalateduetomaternalambientairpollutionexposureacallforfurtherresearchinsouthafrica AT garethemurray theriskoforofacialcleftlippalateduetomaternalambientairpollutionexposureacallforfurtherresearchinsouthafrica AT operationsmile theriskoforofacialcleftlippalateduetomaternalambientairpollutionexposureacallforfurtherresearchinsouthafrica AT caradeeywright riskoforofacialcleftlippalateduetomaternalambientairpollutionexposureacallforfurtherresearchinsouthafrica AT thandikapwata riskoforofacialcleftlippalateduetomaternalambientairpollutionexposureacallforfurtherresearchinsouthafrica AT biancawernecke riskoforofacialcleftlippalateduetomaternalambientairpollutionexposureacallforfurtherresearchinsouthafrica AT helenmalherbe riskoforofacialcleftlippalateduetomaternalambientairpollutionexposureacallforfurtherresearchinsouthafrica AT kurtwbutow riskoforofacialcleftlippalateduetomaternalambientairpollutionexposureacallforfurtherresearchinsouthafrica AT natashanaidoo riskoforofacialcleftlippalateduetomaternalambientairpollutionexposureacallforfurtherresearchinsouthafrica AT rebeccamgarland riskoforofacialcleftlippalateduetomaternalambientairpollutionexposureacallforfurtherresearchinsouthafrica AT anzeldelange riskoforofacialcleftlippalateduetomaternalambientairpollutionexposureacallforfurtherresearchinsouthafrica AT garethemurray riskoforofacialcleftlippalateduetomaternalambientairpollutionexposureacallforfurtherresearchinsouthafrica AT operationsmile riskoforofacialcleftlippalateduetomaternalambientairpollutionexposureacallforfurtherresearchinsouthafrica |