Respiratory involvements among women exposed to th

Authors: Md Abdul Alim Mohammad Abul Bashar Sarker Shahjada Selim Md Rizwanul Karim Yoshitoku Yoshida Nobuyuki Hamajima

Publish Date: 2013/10/09

Volume: 19, Issue: 2, Pages: 126-134

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Abstract

Burning of biomass fuel cowdung crop residue dried leaves wood etc in the kitchen releases smoke which may impair the respiratory functions of women cooking there This paper aimed to compare the respiratory symptoms between biomass fuel users and gas fuel users in BangladeshThe prevalence of respiratory involvement at least one among nine symptoms and two diseases was significantly higher among biomass users than among gas users 299 vs 112  After adjustment for potential confounders by a logistic model the odds ratio OR of the biomass users for the respiratory involvement was significantly higher OR = 323 95  confidence interval 130–801 The biomass fuel use elevated symptoms/diseases significantly the adjusted OR was 304 for morning cough 741 for nasal allergy and 594 for chronic bronchitis The mean peak expiratory flow rate of biomass users 25383 l/min was significantly lower than that of gas users 28237 l/minThe study shows significant association between biomass fuel use and respiratory involvement among rural women in Bangladesh although the potential confounding of urban/rural residency could not be ruled out in the analysis The use of smokefree stoves and adequate ventilation along with health education to the rural population to increase awareness about the health effects of indoor biomass fuel use might have roles to prevent these involvementsNearly onethird of the world’s population and threequarters of rural households in developing countries still rely on unprocessed biomass fuel such as wood cowdung and crop residues for cooking and heating 1 Cooking and heating with such solid fuel is the major source of indoor air pollution IAP and the pollution levels exceed the standard allowable limits in developing countries 2 According to the World Health Organization IAP from burning of biomass fuel has emerged as one of the top ten global threats to public health as it accounts for 27  of the global burden of disease Especially for women and children who spend most time indoors during cooking the levels of exposure to polluted air are reported to be higher 3 IAP is the second largest global environmental contributor to morbidity and it causes 22–28 million deaths annually 4 Polluted indoor air contains a range of healthdamaging pollutants such as carbon monoxide CO carbon dioxide CO2 nitrogen dioxide NO2 sulfur dioxide SO2 volatile organic compounds VOCs and particulate matter 5 6 7 8 These pollutants are able to cross the alveolar–capillary barrier and penetrate deep into the lungs 9A metaanalysis of 25 studies has reported associations between domestic use of solid biomass fuel wood dung crop residue etc and diverse respiratory diseases in rural populations 10 The respiratory effects of chronic exposure to wood smoke and other forms of biomass for adults in developing countries increase the prevalence of chronic bronchitis 11 12 13 respiratory failure and cor pulmonale 13 14 Another metaanalysis of biomass smoke effects on chronic obstructive pulmonary disease COPD found that biomass smoke exposure elevated significantly the risk of COPD compared to those not exposed to biomass smoke especially among women 15 A study conducted in Nepal showed that biomass smoke caused significantly more respiratory disorders than cleaner fuels did 16 Several randomized control trials in rural Mexico have shown cleaner fuels were significantly associated with a reduction of respiratory symptoms among women 17 A study in Pakistan found a strong association with chronic bronchitis in biomassusingr women when compared with liquid petroleum LP gasusing women 18Almost all of these studies were conducted in rural areas while attempting to assess the respiratory health of women and children and no study has compared cooking by women in rural versus urban settings However differences in the indoor air quality IAQ between urban and rural areas in developing countries can be bigger due to the gaps between the factors contributing to the IAQ of rural and urban areas such as house and kitchen structure ventilation lifestyle source of outdoor air pollutants and population density 19 Thus understanding the respiratory involvement of smoke due to the combustion of biomass and gas fuel among women in both urban and rural areas in developing countries is one of the prioritized steps for taking countermeasures to prevent women’s respiratory morbidityAlmost twothirds of the population of Bangladesh dwells in rural areas Most of them have poor living conditions and almost all of them use poorly ventilated kitchens or cooking spaces 20 About 94  of the rural people in Bangladesh use biomass in the form of wood straw leaf and dried cowdung as a cooking fuel while only 45  use LP gas 1  kerosene and 03  use electricity 21 Those sticking to their old tradition of cooking indoors on threestone stoves especially women are at risk of developing respiratory diseases associated with biomass fuel However very little attention has been focused in Bangladesh on this important aspect of public health Several studies conducted in rural and urban areas of Bangladesh have measured the concentrations of pollutants from the burning of biomass fuel in the kitchen and associations of respiratory involvements on children under 5 years old 3 19 22

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