High sensitivity C - reactive protein (hscrp) among persons exposed to air pollution in Kampala city: a pilot study
Okello, Clement Dove
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BACKGROUND Ischaemic heart disease (IHD) is on the rise in Uganda as depicted by the increased admissions of patients with such conditions in Mulago hospital. Most of these patients do not have the traditional risk factors such as cigarette smoking and obesity that are predominant in the western world. Air pollution has been proposed as an emerging risk factor for ischaemic heart disease as it leads to increased expression of adhesion molecules and selectins, whose soluble forms can be detected in blood. There has been significant increase in air pollution in Kampala city and the nearby suburbs. Most patients in Mulago hospital are resident in Kampala city and its suburbs. OBJECTIVES To compare high sensitivity C-Reactive Protein (hsCRP) levels in persons resident and working in a place with a high air pollution level (Urban, Kibuli parish) to those of persons resident and working in a place with low air pollution level (Rural, Ntawo parish). METHODS This was a comparative cross-sectional study carried out in an urban setting believed to have high air pollution level (Kibuli parish in the central business area of Kampala capital city authority) and a rural setting believed to have low air pollution level (Ntawo parish in Mukono district). The parishes were chosen according to information from the National environmental management authority (NEMA) of Uganda which however was given without measurements of air quality. Twenty five (25) participants were recruited from their households in each parish by systematic sampling method. History of the risk factors for exposure to air pollution was obtained from participants, focused physical examination and blood tests were also done. The primary variable was hsCRP. Data were analyzed using Stata. Demographic and physical characteristics were described among the two study groups. Continuous variables were expressed as medians and inter quartile ranges (IQR) and means and standard deviation (SD). Normally distributed variables were compared using t-tests, and non-normally distributed variables compared using Wilcoxon rank sum tests. Nominal variables were expressed as frequencies and percentages and compared using chi-square test or Fischer’s exact test. The level of significance was set at a p value of <0.05. RESULTS The median hsCRP in participants from Kibuli and Ntawo were 0.9mg/L (IQR 0.5 - 2.7) and 0.9mg/L (IQR 0.4 - 2.1), p=0.977 respectively. Thirteen (52%) of the participants from Kibuli and 13 (52%) of the participants from Ntawo had hsCRP <1mg/L, p=1.000. Six (24%) of the participants from Kibuli and 6 (24%) of the participants from Ntawo had hsCRP of 1-3mg/L, p=1.000. Six (24%) of the participants from Kibuli and 6 (24%) of the participants from Ntawo had hsCRP >3mg/L, p = 1.000. CONCLUSIONS AND RECOMMENDATIONS There was no significant difference in the hsCRP levels between participants from Kibuli parish (urban) and those from Ntawo parish (rural). However, a considerable number of participants from both Kibuli and Ntawo parishes had hsCRP level in the category of high risk for ischaemic heart disease based on the Centers for Disease Control and Prevention and the American Heart Association (CDC/AHA) guideline. The findings in this study should awaken the concerned bodies to come up with measures to monitor air quality in Kampala city and to limit factors that increase air pollution such as restriction of waste burning, controlled industrial and vehicular emissions among other things. We would also recommend comparative studies in sites with measured differences in particulate matter, especially PM2.5 and to examine the impact of indoor air pollution in relation to hsCRP in Uganda.