Introduction: In Timor-Leste, anemia affects approximately 21% of reproductive age of women. The established risk factor for anemia is poor nutritional status, but recently solid fuel use in the household has emerged as a possible risk factors. The association between solid fuel and anemia has been studied in children and pregnant women, but there hasn’t been a study conducted to find the association among all reproductive age women from 15-49 years old. Aim: The objective of this study is to determine if use of solid fuels (charcoal, wood, and straw/shrubs/grass) compared to cleaner fuels (electricity, LPG. natural gas, biogas, and kerosene) associated with the increasing of the prevalence of anemia among reproductive age women (15-49 years old) in Timor-Leste. Methods: This study used data from the Timor-Leste Demographic Health Survey (TLDHS) 2009-2010. The data used was based on the individual level within household from 13 districts in Timor-Leste. Bivariable logistic regression analysis was performed to assess associations between each independent variable (type of fuels, age group, BMI group, residence, wealth index, education level and smoking behavior) and the outcome variable (anemia) and mutlivariable logistic regression model was also performed with significant covariates. Results: The association based on the type of fuels showed that the odds ratio for anemia in women using solid fuels was 1.73 (OR: 95% CI: 1.49 - 2.01) compared to the women using cleaner fuels. After adjustment for other covariates, the odds ratio for anemia in women that use solid fuels was 1.43 (95% CI: 1.29-1.64) compared to women using cleaner fuels. Discussion: Based on our study population, this study found that reproductive age women 15-49 years old in Timor-Leste who used solid fuel as a source of energy for cooking or heating activities in the household were at higher risk for anemia.

Poor air quality has been projected to be the world’s top cause of environmental premature mortality by 2050 surpassing poor sanitation and dirty water (IGBP / IGAC press release, 2012 ). One of the major challenges of air quality management is how to adequately quantify both the spatial and temporal variations of pollutants for the purpose of implementing necessary mitigation measures. The work described in this thesis aims to address this problem using novel electrochemical based air quality (AQ) sensors. These instruments are shown to provide cost effective, portable, reliable, indicative measurements for urban air quality assessment as well as for personal exposure studies. Three principal pollutants CO, NO and NO2 are simultaneously measured in each unit of the AQ instrument including temperature / RH measurements as well as GPS (for time and position) and GPRS for data transmission. Laboratory studies showed that the electrochemical sensor nodes can be highly sensitive, showing linear response during calibration tests at ppb level (0-160 ppb). The instrumental detection limits were found to be < 4 ppb (CO and NO) and < 1 ppb for NO2 with fast response time equivalent to t90 < 20 s. Several field studies were carried out involving deployment of both the mobile and static electrochemical sensor nodes. Results from some short-term studies in four different cities including Cambridge (UK), London (UK), Valencia (Spain) and Lagos (Nigeria) are presented. The measurements in these cities represent snapshot of the pollution levels, the stark contrast between the pollution level especially CO (mean mixing ratio of 16 ppm over 3 hrs) in Lagos and the other three cities is a reflection of the poor air quality in that part of the world. Results from long-term AQ monitoring using network of 46 static AQ sensors were used to characterise pollution in different environments ranging from urban to semi-urban and rural locations. By coupling meteorological information (wind measurements) with pollution data, pollution sources, and phenomena like the street canyon effect can be studied. Results from the long-term study also revealed that siting of the current fixed monitoring stations can fail to represent the actual air quality distribution and may therefore be unrepresentative. This work has shown the capability of electrochemical based AQ sensors in complementing the existing fixed site monitors thus demonstrating an emerging measurement paradigm for air quality monitoring and regulation, source attribution and human exposure studies.

La sclérose en plaques (SEP) est une maladie neuro-inflammatoire du système nerveux central. Les causes sont multifactorielles impliquant à la fois une prédisposition génétique et l'influence de facteurs environnementaux. Dans environ 85% des cas, les patients sont atteints de poussées correspondants à la survenue de signes neurologiques, suivis d'une phase de rémission partielle ou totale. De nombreux travaux avancent l'hypothèse selon laquelle le taux de poussées varie au gré des saisons, survenant plus fréquemment au printemps et en été. Cette fluctuation temporelle a soulevé la question de l'influence de paramètres dépendants de la saison tels que l'ensoleillement et le statut en vitamine D, le niveau de mélatonine ou encore la pollution atmosphérique. Etant donné cette variation de la pollution de l'air, nous avons cherché à explorer l'impact à court terme des particules fines (PM10), benzène (C6H6), dioxyde d'azote (NO2), monoxyde de carbone (CO) et de l'ozone troposphérique (O3), sur le risque de déclenchement de poussée, indépendamment des saisons "chaude" (1er avril au 30 septembre) et "froide" (1er octobre au 31 mars). Ce travail s'est appuyé sur les données de patients issus du réseau ville-hôpital alSacEP. Nous avons sélectionné 424 patients atteints de SEP à début rémittent et ayant connu un total de 1 783 poussées (2000-2009). Les niveaux journaliers de pollution, produits grâce au modèle physique déterministe ADMS-Urban, ont été modélisés sur une base horaire pour chaque IRIS de la communauté urbaine de Strasbourg par l'actuelle AASQUA ATMO Grand Est. De plus, une enquête individuelle menée dans le cadre de cette étude auprès de l'ensemble des patients (PT) a permis de collecter (par questionnaire téléphonique ou auto-questionnaire sur internet) des informations personnelles socio-économiques (SES) et du mode de vie pour 188 d'entre eux (PS). Enfin, le niveau SES des IRIS a été estimé à l’aide d’un indice de défaveur social - construit à partir des données du recensement de l’INSEE. Nous avons observé une influence saisonnière délétère à court terme de la pollution (3 jours précédant la poussée) sur le risque de poussée en PT, notamment de l'O3 en saison "chaude" et des PM10 et NO2 en saison "froide". Nos résultats suggèrent également que le contexte SES puisse exacerber ces associations, notamment chez les patients résidant dans les quartiers défavorisés lors d'exposition aux PM10, NO2, C6H6 et CO ("froide") et ceux résidant dans les quartiers favorisés et défavorisés lors de l'exposition à l'O3 ("chaude"). Enfin, nous avons observé chez la PS que le niveau d'éducation faible, le revenu familial moyen, la consommation de cigarette et le manque d'activité physique régulière sont les catégories SES et du mode de vie les plus associées avec le risque de poussée lors de l'exposition à la pollution de l'air. Ce travail montre la nécessité d'étudier les expositions environnementales au cours de la SEP selon une approche holistique intégrant des facteurs individuels et contextuels. / Multiple sclerosis (MS) is a neuro-inflammatory disease of the central nervous system (CNS). Causes are multifactorial enrolling both genetic predisposition and influence of environmental factors. In 85% of cases, patients experience relapse corresponding to the occurrence of neurologic signs, followed by a phase of partial or total remission. Several studies put forth the hypothesis that relapses rate varies across season, mainly occurring during spring and summer. This temporal fluctuation raised the question of season-dependent parameters influence such as sunlight exposure and vitamin D, melatonin level or ambient air pollution. Considering this variation of air pollution, we explored the short-term impact of fine particles (PM10), benzene (C6H6), nitrogen dioxide (NO2), carbon monoxide (CO) and ground-level ozone (O3), on the risk of relapse triggering, separately for "cold" (i.e., October-March) and "hot" (April-September) season. This work has drawn from data of patients provided by the alSacEP network. We included 424 patients affected with remitting MS onset who experienced 1,783 relapses over the 2000-2009 period. Daily level of air pollution was modeled through ADMS-Urban software at the census block scale of the Strasbourg metropolitan area (AASQA ATMO Grand Est). Furthermore, an individual survey was conducted among all the patients (PT) in order to collect individual socioeconomic (SES) and lifestyle features. Finally, the census block SES position was estimated using a composite deprivation index - created from the INSEE census data. A short-term (3 days preceding the relapse) seasonal adverse effect was observed in PT, in particular during exposure to O3 in "hot" season and PM10 and NO2 in "cold" season. Results also suggest that the SES context might exacerbate these associations, in particular among patients who were living in deprived neighborhood with exposure to PM10, NO2, C6H6 and CO ("cold) and those who were living in most well-of and deprived places with exposure to O3 ("hot"). Finally, we observed among Ps that low education level, average family income, smoking and lack of physical activity are more associated with the risk of relapse triggering when patients were exposed to air pollution. This work shows the need to investigate environmental exposure such as air pollution along the SEP course using a holistic approach integrating individual and contextual factors.