{
  "abstract": "Climate change has been assumed as a key contributor to global undernutrition. One possible channel is that global warming increases air pollution exposure by causing more and more wildfires. This study examined the effect of wildfire-sourced particulate matter (PM)2.5 exposure on anaemia in women of reproductive age (WRA), a dominating form of undernutrition across the low- and middle-income countries (LMICs). We collected haemoglobin measurements of 1 549 972 WRA from 85 Demographic and Health Surveys (DHS) in 45 LMICs between 2004 and 2021. Wildfire-sourced PM2.5 exposure was estimated through a synthesis of ground observations, satellite remote sensing measurements and the Goddard Earth Observing System with Chemistry (GEOS-Chem) model simulations. The effects on the haemoglobin levels, as well as the odds of anaemia, were estimated by the mixed-effects regression models. Finally, population-attributable fraction or number was calculated to assess the burden of wildfire-sourced anaemia among WRA, by extrapolating the regression model result to a study domain of 125 LMICs. In the fully adjusted model, a 1 μg/m³ increase in wildfire-sourced PM2.5 was associated with a 0.1263 g/L reduction in the haemoglobin levels of women (95% CI −0.1540 to –0.0987) and a 1.3% increase in odds of anaemia (ORs 1.013, 95% CI 1.010 to 1.016). The non-linear analysis showed a monotonically increasing exposure-response relationship, which suggested a saturated effect for an exposure concentration >5.85 μg/m³. Across the study domain of 125 LMICs, wildfire-sourced PM2.5 contributed to WRA anaemia of 35.9 million (95% CI 30.1 to 42.1) in 2000, rising to 52.8 (95% CI 44.3 to 61.9) in 2019. The numbers accounted for 8.81% (95% CI 7.38% to 10.32%) and 9.54% (95% CI 7.99% to 11.17%) of all anaemic WRA, respectively. To meet the global 2030 target of reducing 50% WRA anaemia, warranted are climate mitigations and adaptations against wildfire smoke exposure.",
  "authors": [
    {
      "affiliations": [
        "Dong Fureng Institute of Economic and Social Development, School of Public Health, Wuhan University, Wuhan, Hubei, China"
      ],
      "name": "An Xiaofei"
    },
    {
      "affiliations": [
        "Institute of Reproductive and Child Health / National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics / Ministry of Education Key Laboratory of Epidemiology of Major Diseases (PKU), School of Public Health, Peking University Health Science Center, Beijing, China"
      ],
      "name": "Ning Kang"
    },
    {
      "affiliations": [
        "School of Nursing, Peking University Health Science Centre, Beijing 100191,China, Peking University, Beijing, Beijing, China",
        "Advanced Institute of Information Technology, Peking University, Hangzhou, Zhejiang, People's Republic of China"
      ],
      "name": "Pengfei Li"
    },
    {
      "affiliations": [
        "Institute of Reproductive and Child Health / National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics / Ministry of Education Key Laboratory of Epidemiology of Major Diseases (PKU), School of Public Health, Peking University Health Science Center, Beijing, China"
      ],
      "name": "Mingkun Tong"
    },
    {
      "affiliations": [
        "State Key Joint Laboratory of Environment Simulation and Pollution Control, College of Environmental Sciences and Engineering, Peking University, Beijing100871, China, Peking University, Beijing, China"
      ],
      "name": "Fangzhou Li"
    },
    {
      "affiliations": [
        "Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, Hubei, China"
      ],
      "name": "Tong Jiahui"
    },
    {
      "affiliations": [
        "Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, Hubei, China"
      ],
      "name": "Xu Huaiyue"
    },
    {
      "affiliations": [
        "Institute of Reproductive and Child Health / National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics / Ministry of Education Key Laboratory of Epidemiology of Major Diseases (PKU), School of Public Health, Peking University Health Science Center, Beijing, China",
        "Advanced Institute of Information Technology, Peking University, Hangzhou, Zhejiang, People's Republic of China"
      ],
      "name": "Xue Tao"
    },
    {
      "affiliations": [
        "Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, Hubei, China"
      ],
      "name": "Hao Xiang"
    }
  ],
  "title": "Estimating the burden of anaemia in women of reproductive age attributable to wildfire-sourced fine particulate matter: a multicentre cross-sectional study in low- and middle-income countries",
  "uid": "43df0755-5a33-5cac-950e-42346cd62a7a"
}