Obstructive airway diseases in women exposed to biomass smoke

The majority of women living in rural areas in Turkey use biomass fuels for domestic energy and are exposed to high levels of indoor air pollution every day. The objective of this study was to compare the presence of chronic airway diseases (CAD) in two groups of nonsmoking women older than 40 years with (exposed group, n=397) and without a history of exposure to biomass cooking (liquid petroleum gas (LPG); control group, n=199), in 2002 in Kirikkale, Turkey. Detailed respiratory symptoms were collected with a standard questionnaire adapted from that of the British Medical Research Council. Exposure was calculated as the average hours spent daily for cooking multiplied by the number of years. CAD were defined as either chronic airway obstruction (CAO; (forced expiratory volume in 1s/forced vital capacity)<0.70), chronic bronchitis, or chronic bronchitis with CAO. The prevalence of CAD in the exposed group was found to be higher than that in the LPG group (28.5% vs. 13.6%, crude odds ratios (ORs) 2.5 (1.5--4.0), P=0.0001). The fraction of CAD attributed to exposure to biomass smoke after adjusting for possible confounding factors was 23.1% (95% confidence interval (CI) 13.4--33.2). Acute symptoms during exposure to biomass smoke were important predictors for the presence of CAD. Biomass smoke pollution is an important contributing factor in the development of CAD in nonsmoking women living in a rural area. The presence of acute symptoms during cooking in women in rural areas should signal to general practitioners the possibility of CAD.     

Respiratory effects and arsenic contaminated well water in Bangladesh

Arsenic in drinking water causes a widespread concern in Bangladesh, where a major proportion of tube wells is contaminated. Arsenic ingestion causes skin lesions, which is considered as definite exposure. A prevalence comparison study of respiratory effects among subjects with and without arsenic exposure through drinking water was conducted in Bangladesh. Exposed participants were recruited through health awareness campaign programs. Unexposed participants were randomly selected, where tubewells were not contaminated with arsenic. A total of 169 individuals participated (44 exposed individuals exhibiting skin lesions; 125 unexposed individuals). The arsenic concentrations ranged from 136 to 1000 micro g l(-1). The information regarding respiratory system signs and symptoms were also collected and the analyses were confined to nonsmokers. The crude prevalence ratio for chronic bronchitis and chronic cough amounted to 2.1 (95% CI 0.7-6.1). The prevalence ratios for chronic bronchitis increased with increasing exposure, i.e., 1.0, 1.6, 2.7 and 2.6 using unexposed as the reference. The prevalence ratios for chronic cough were 1.0, 1.6, 2.7 and 2.6 for the exposure categories, using the same unexposed as the reference. The dose-response trend was the same (P < 0.1) for both conditions. These results add to evidence that long-term ingestion of arsenic exposure can cause respiratory effects.     

Solid fuel use is a major risk factor for acute coronary syndromes among rural women: a matched case control study

Objectives

Almost half of the world's population uses solid fuel for cooking, exposing women to high levels of particulate pollution in indoor air. The risk of acute coronary syndrome (ACS) was assessed among rural women, according to their use of solid fuel.

Study design

Matched case control study.

Methods

Data were collected at a public tertiary care hospital in a rural district of Pakistan. Seventy-three women with ACS were compared with controls, individually matched for sex and age (±5 years), who were admitted to hospital for other reasons. Fuels used for cooking and exposures to potentially confounding variables were ascertained through a questionnaire administered at interview and measurement of height and weight. Conditional logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (95% CIs).

Results

After adjustment for potential confounding factors, current use of solid fuel was strongly associated with ACS (OR 4.8, 95% CI: 1.5–14.8), and risk was lowest in women who had last used solid fuel more than 15 years earlier. The population attributable fraction for ACS in relation to current use of solid fuel was 49.0% (95% CI: 41.3%–57.4%).

Conclusions

These findings support the hypothesis that indoor air pollution from use of solid fuel is an important cause of ACS. Our study demonstrates the feasibility of case-control studies in rural populations of women to address this question, and is an encouragement to larger and statistically more powerful investigations.     

2014年中国40岁及以上女性人群烹饪生物燃料暴露状况

目的 了解2014－2015年我国≥40岁女性烹饪生物燃料暴露情况,为生物燃料暴露防控工作提供参考信息。方法 调查对象来源于2014－2015年中国COPD监测。在中国31个省（自治区、直辖市）选取125个监测点,采用多阶段分层整群抽样的方法,通过面对面询问调查方式收集相关信息,共调查≥40岁女性37 795人。对样本进行复杂加权后,分析不同特征女性烹饪生物燃料暴露情况。结果 纳入分析的有效样本为37 777人。经复杂加权后,我国≥40岁女性人群的烹饪生物燃料暴露率为35.8%（95% CI：29.6%～42.1%）,乡村高于城镇（P<0.001）。七大地理区≥40岁女性生物燃料暴露率的差异有统计学意义（χ²=17.03,P=0.009）,东北地区最高,华北地区最低。烹饪生物燃料暴露率随文化程度增加呈下降趋势（P<0.001）。结论 我国≥40岁女性人群烹饪生物燃料暴露水平较高,尤其是乡村地区,且存在年龄和地区差异。应根据当地具体情况,因地制宜,采取合适措施降低生物燃料暴露水平。     

Indoor air pollution and health of children in biomass fuel-using households of Bangladesh: comparison between urban and rural areas

Objectives  

Indoor air pollutants from biomass combustion pose a risk for respiratory diseases in children. It is plausible that distinct differences in the indoor air quality (IAQ) exist between urban and rural areas in developing countries since the living environment between these two areas are quite different. We have investigated possible differences in IAQ in urban and rural Dhaka, Bangladesh and the association of such differences with the incidence of respiratory and some non-respiratory symptoms in children of families using biomass fuel.     

Feasibility and acceptability of a midwife-led health education strategy to reduce exposure to biomass smoke among pregnant women in Uganda,A FRESH AIR project

ABSTRACT

Biomass smoke exposure is a threat to child and maternal health in many resource-limited countries and is associated with poor pregnancy outcomes and serious lung diseases in the offspring. We aimed to assess the feasibility, acceptability and impact of a midwife-led education programme on biomass risks and prevention for women attending maternity clinics in Uganda. Education materials were co-developed through an iterative process by midwives and other stakeholders. The materials were serially tested and approved by the Ministry of Health and used by midwives and village health teams (VHTs). The district health team, 12 midwives and 40 VHTs were sensitised on biomass smoke. Two hundred and forty-four women were educated about biomass smoke by midwives; pre- and post-session questionnaires showed major improvements in knowledge of biomass smoke risks. Qualitative interviews with women three months after the sessions showed that they made behavioural changes such as avoiding smoke while cooking, using dry wood, solar power for lighting and improved ventilation. The major barrier to behavioural changes was poverty, but some improvements cost no money. The programme delivered by midwives was feasible and acceptable; implementing this programme has the potential to reduce exposure to smoke with major benefits to mother, foetus, and children throughout their lives.     

An evaluation of a micro-credit system to promote health knowledge among poor women in Bangladesh

A Micro-credit system (MCS) is a financial system to support the economic needs of the poor. It is thought of as a community-based method to solve various problems, including the lack of health-related knowledge. Participants are organized in groups that assemble in regular meetings. Hadi (Hadi in Health Promotion International 16, 219-227, 2001) investigated the MCS as a method to solve the lack of health-related knowledge among the poor in Bangladesh. His result among rural MCS participants shows a positive relationship between the duration of membership in a micro-credit group and health knowledge. Further, more knowledge was ascertained among participants than among non-participants. The present research investigated the effectiveness of the MCS in increasing health-related knowledge. Comparisons were made between rural and urban groups on the basis of three different durations of membership and the influence of TV. This three-factorial design shows a significant increase in knowledge in a very short period in rural areas, whereas in urban areas, no systematic increase was found. TV plays a significant roll in increasing knowledge. Different theoretical conclusions are discussed on the basis of the results.     

COVID-19 vaccine decision-making among pregnant and lactating women in Bangladesh

Pregnant and lactating women’s vaccine decision-making process is influenced by many factors. Pregnant women were at increased risk for severe disease and poor health outcomes from COVID-19 at various time points during the pandemic. COVID-19 vaccines have been found to be safe and protective during pregnancy and while breastfeeding. In this study, we sought to examine key factors that informed the decision-making process among pregnant and lactating women in Bangladesh. We conducted 24 in-depth interviews, with 12 pregnant and 12 lactating women. These women were from three communities in Bangladesh: one urban community, and two rural communities. We used a grounded theory approach to identify emerging themes and organized emerging themes using a socio-ecological model. The socio-ecological model suggests that individuals are influenced by many levels, including individual-level influences, interpersonal-level influences, health care system-level influences, and policy-level influences. We found key factors at each socio-ecological level that influenced the decision-making process of pregnant and lactating women, including perceived benefits of vaccines and vaccine safety (individual-level), the influence of husbands and peers (interpersonal-level), health care provider recommendations and vaccine eligibility (health care system-level), and vaccine mandates (policy-level). As vaccination can reduce the effect of COVID-19 disease in mothers, infants, and unborn children, targeting critical factors that inform the decision-making process is paramount for improving vaccine acceptance. We hope the results of this study will inform vaccine acceptance efforts to ensure that pregnant and lactating women take advantage of this life-saving intervention.     

Physical violence by husbands: magnitude, disclosure and help-seeking behavior of women in Bangladesh

This paper explores the magnitude of physical violence by husbands, the disclosure of it and the help-seeking behavior of abused women in urban and rural Bangladesh. The data come from a larger study on domestic violence against women conducted in Bangladesh during 2000-2004. All ever-married women covered by the population-based survey component (n=2702) conducted in 2001 were included in the current analysis. We also draw on in-depth interviews with 28 women who were physically abused by their husbands. Results show a high prevalence of lifetime physical spousal violence against women: 40% in urban and 42% in rural areas. Most of the abused women (66%) were silent about their experience. The main reasons behind this silence were high acceptance of violence, stigma and fear of greater harm. Sixty percent of urban and 51% of rural abused women never received any help from others. Only 2% ever sought help from institutional sources, from where support was not forthcoming. Women approached these sources only when they could not endure anymore or the violence became life threatening or children were at risk. The findings show that although providing appropriate services is absolutely necessary, it is also important to foster the use of such services and to help women overcome the barriers for accessing these services.     

Prevalence of chronic bronchitis-asthma symptoms in biomass fuel exposed females

Objectives We investigated whether exposure to biomass fuel is a potential risk factor for chronic bronchitis and asthma among females in rural area in Van (east Turkey). Methods The effect of indoor pollution producing various respiratory symptoms was studied in 177 females. Of these, 90 were those who used biomass fuel and 87 were nonusers of biomass fuel. A part of the European Community Respiratory Health Survey quastionnaire and British Medical Research Council questionnaire were used. Results Asthma related symptoms (AS) (wheezing, and combination of wheezing without a cold and wheezing with breathlessness) were reported in 63.3% of those who used biomass fuel, and in 12.9% of nonusers (p<0.0001). The use of asthma medication was reported as 3.3% of biomass fuel users, and in 2.7% of nonuser (p>0.05). Long term cough and/or morning cough together with sputum (chronic bronchitis symptoms (BS) was reported as 58.9% in the user group, and 29.4% in the nonuser group (p<0.0001). Significant differences in AS and BS were found between biomass fuel user and nonuser groups in the rural area. Conclusions The results of this study showed a significant association between symptoms of chronic bronchitis-asthma and biomass fuel usage in females living in a rural area.     

Multiple approaches to evaluate the toxicity of the biomass fuel cow dung (kanda) smoke

Cow dung (Kanda) is a major source of energy in rural and urban population of developing countries and is burnt in traditional open stoves in confined space of kitchen without proper ventilation. In epidemiological studies, biomass fuel smoke has been reported to be responsible for several respiratory disorders in exposed population. In a laboratory experiment, female wistar rats were exposed to kanda smoke for 60 min/day over a period of 12 weeks. Chemical analysis of smoke showed the presence of PAHs. The increase in CYP1A1, GST-ya, GST-yc expression was found in 12 week exposed lung tissues as compared with controls. The exposure to smoke resulted in significant alteration in the BALF cells in the form of clustering of alveolar macrophages and giant cell formation with vacuolated cytoplasm. The macrophages also showed thickness and villi like projections on the cell surface thus reducing their phagocytic activities. Histopathological changes in lung tissue were manifested in the form of damage to bronchiolar epithelium, edema and thickening of alveolar septa and emphysema after 4 and 8 week of exposure. These findings suggest that exposure to kanda smoke increases pulmonary tissue damage and may result in various forms of respiratory infections in the exposed popultion.     

Variations in perinatal mortality associated with different polluting fuel types and kitchen location in Bangladesh

This study examines the association between household air pollution from use of polluting cooking fuels and perinatal mortality in Bangladesh. We analysed the data from the Bangladesh Demographic and Health Surveys (BDHS) 2004, 2007, 2011, and 2014. The two outcome variables were stillbirth and early neonatal mortality. The exposure variable was type of primary cooking fuel used in the household (clean vs. polluting). Bivariate and multivariable analyses were conducted to obtain the crude and adjusted odds ratio (aOR), respectively. In the adjusted model, the exposure to polluting fuels was associated with early neonatal mortality (aOR: 1.46, 95% confidence interval [CI]: 1.01–2.10), but not with stillbirth (aOR: 1.25, 95% CI: 0.85–1.84). The effect of cooking with agricultural crop waste was greater for stillbirth (aOR: 1.76, 95% CI: 1.10–2.80) and for early neonatal mortality (aOR: 1.78, 95% CI: 1.13–2.80) which was also associated with wood as the main fuel (aOR: 1.52, 95% CI: 1.04–2.21). Using polluting fuels in an indoor kitchen was associated with an increased odds of stillbirth (aOR: 4.12, 95% CI: 1.49–11.41). Cooking with polluting fuels is associated with perinatal mortality. The combined association of polluting cooking fuels and indoor kitchen location was greater for stillbirth. This effect and the effect of different fuel types need further investigation. Although this is a large sample, there are some limitations with the BDHS data in both recording the exposure and the outcomes. A large prospective trial is needed to determine the precise effect size.     

Social networks and contraception practice of women in rural Bangladesh

This paper analyzed the association of social networks with contraceptive use using both structural and attitudinal properties of social networks. Data were collected from seven villages in rural Bangladesh by face-to-face interviews using a structured questionnaire (N = 694). Sociometric data and the centrality positions of women in their social networks were analyzed as proxies for structural properties, and the perception of network members’ approval and encouragement towards family planning as attitudinal properties. The perception of network members’ attitude towards family planning and power within networks was found to be positively associated with contraception use. The strong association of the social network members’ encouragement of contraception and the significance over both in-degree (number of nominations received by the participant from other village women) and out-degree centrality (number of nominations given by a participant) provides further confirmation that immediate network members’ attitude is important to explain current contraceptive use of women in rural Bangladesh.     

Effects of cooking fuel smoke on respiratory symptoms and lung function in semi-rural women in Cameroon

Background:

Indoor air pollution is a major health problem in the developing world. In sub-Saharan Africa more than 90% of people rely on biomass to meet their domestic energy demands. Pollution from biomass fuel ranks 10th among preventable risk factors contributing to the global burden of diseases.

Objectives:

The present study aimed to determine the prevalence of respiratory symptoms and the factors associated with reduced lung function in a population of women exposed to cooking fuel smoke.

Methods:

A cross-sectional study was conducted in a semi-rural area in Cameroon. We compared forced respiratory volume between women using wood (n = 145) and women using alternative sources of energy (n = 155) for cooking.

Results:

Chronic bronchitis was found in 7·6% of the wood smoke group and 0·6% in the alternative fuels group. We observed two cases of airflow obstruction in the wood smoke group. Factors associated with lung function impairment were chronic bronchitis, use of wood as cooking fuel, age, and height.

Conclusion:

Respiratory symptoms and reduced lung function are more pronounced among women using wood as cooking fuel. Improved stoves technology should be developed to reduce the effects of wood smoke on respiratory health.     

Effectiveness of the 10-valent pneumococcal conjugate vaccine against radiographic pneumonia among children in rural Bangladesh: A case-control study

BackgroundPneumococcal conjugate vaccine (PCV) effectiveness against radiographic pneumonia in South Asia is unknown. Bangladesh introduced PCV10 in 2015 using a three dose primary series (3 + 0). We sought to measure PCV10 effectiveness for two or more vaccine doses on radiographic pneumonia among vaccine-eligible children in rural Bangladesh.MethodsWe conducted a matched case-control study over two years from 2015 to 2017 using clinic and community controls in three subdistricts of Sylhet, Bangladesh. Cases were vaccine eligible 3–35 month olds at Upazila Health Complex outpatient clinics with World Health Organization-defined radiographic primary endpoint pneumonia (radiographic pneumonia). Clinic controls were matched to cases within a one week time window by age, sex, and clinic and had an illness unlikely to be Streptococcus pneumoniae; community controls were healthy and similarly matched within a one week time window by age and sex, and distance from the clinic. We estimated adjusted vaccine effectiveness (aVE) using conditional logistic regression.ResultsWe matched 1262 cases with 2707 clinic and 2461 community controls. Overall, aVE using clinic controls was 21.4% (95% confidence interval, −0.2%, 38.4%) for ≥2 PCV10 doses and among 3–11 month olds was 47.3% (10.5%, 69.0%) for three doses. aVE increased with higher numbers of doses in clinic control sets (p = 0.007). In contrast, aVE using community controls was 7.6% (95% confidence interval, −22.2%, 30.0%) for ≥2 doses. We found vaccine introduction in the study area faster and less variable than expected with 75% coverage on average, which reduced power. Information bias may also have affected community controls.ConclusionsClinic control analyses show PCV10 prevented radiographic pneumonia in Bangladesh, especially among younger children receiving three doses. While both analyses were underpowered, community control enrollment – compared to clinic controls – was more difficult in a complex, pluralistic healthcare system. Future studies in comparable settings may consider alternative study designs.     

A performance assessment of arsenic-iron removal plants in the Manikganj district of Bangladesh

In Bangladesh, arsenic contamination of groundwater, microbial contamination of surface water and seasonally variable rainfall make reliable access to acceptable quality drinking water a challenge. Arsenic-iron removal plants (AIRPs) are a relatively inexpensive way of removing arsenic from groundwater for access to safer drinking water. This study evaluated the performance of 21 (of 105) AIRPs installed by a local non-governmental organization (Society for People's Action in Change and Equity) with financial assistance from the Australian High Commission, Dhaka, under the Direct Aid Program of the Australian Government. All AIRPs achieved the Bangladesh standard for arsenic in drinking water of 50 mg L^-1 and 17 achieved the World Health Organization guideline of 10 mg L^-1. The AIRPs removed 87% of influent arsenic, on average. After cleaning, poor arsenic and iron removal was observed for about 2 days due to inadequate residence time. Chemical processes that may influence AIRP performance are also discussed herein, including iron and arsenic oxidation, arsenic co-precipitation with iron, multiple iron additions, interference by organics, and iron crystallization. Effluent faecal coliform counts were generally low, though were slightly higher than influent counts. Overall, AIRPs were shown to possess considerable promise for use in areas with high natural iron where users are concerned about arsenic and/or iron in their drinking water.     

Utilization of maternal health care services among indigenous women in Bangladesh: A study on the Mru tribe

Despite startling developments in maternal health care services, use of these services has been disproportionately distributed among different minority groups in Bangladesh. This study aimed to explore the factors associated with the use of these services among the Mru indigenous women in Bangladesh. A total of 374 currently married Mru women were interviewed using convenience sampling from three administrative sub-districts of the Bandarban district from June to August of 2009. Associations were assessed using Chi-square tests, and a binary logistic regression model was employed to explore factors associated with the use of maternal health care services. Among the women surveyed, 30% had ever visited maternal health care services in the Mru community, a very low proportion compared with mainstream society. Multivariable logistic regression analyses revealed that place of residence, religion, school attendance, place of service provided, distance to the service center, and exposure to mass media were factors significantly associated with the use of maternal health care services among Mru women. Considering indigenous socio-cultural beliefs and practices, comprehensive community-based outreach health programs are recommended in the community with a special emphasis on awareness through maternal health education and training packages for the Mru adolescents.     

Maternal exposure to biomass smoke and reduced birth weight in Zimbabwe

PURPOSE: To examine the association between household use of biomass fuels for cooking and birth weight. METHODS: Analysis is based on 3559 childbirths in the 5 years preceding the 1999 Zimbabwe Demographic and Health Survey. Birth weights, recorded by trained professionals at local health clinics, were derived from health cards at home or from mother's recall. Multiple regression method was used to estimate the effect of household use of biomass cooking fuels (wood, dung, or straw) on birth weight, after controlling for child's sex and birth order, mother's education and nutritional status, pregnancy care, household living standard, and other potentially confounding factors. RESULTS: Babies born to mothers cooking with wood, dung, or straw were 175 g lighter (95% CI,-300,-50), on average, compared with babies born to mothers using LPG, natural gas, or electricity. The difference was 120 g (95% CI,-301, 61) for children whose birth weights were taken from health cards, and 183 g (95% CI,-376, 10) for children whose birth weights were reported by mothers. CONCLUSIONS: Household use of high pollution cooking fuels may cause reduced birth weight. The relationship needs to be further investigated using more direct measures of smoke exposure and birth weight and accounting for environmental tobacco smoke.     

Characteristics of women exposed and unexposed to environmental tobacco smoke (ETS) in a general population sample of North Italy (Po River Delta epidemiological study)

To define qualitative and quantitative categories of exposure to environmental tobacco smoke (ETS) and to assess possible differences for life-style factors between exposed and unexposed women, we studied 867 nonsmoking women (8–73 aged), selected from a general population sample living in the Po Delta area (near Venice, North Italy). Information was collected by a standardized questionnaire. ETS exposure at home, at work or elsewhere was considered. There was a prevalence of ETS exposure of 46% in the whole sample; the rate had a negative association with age. Exposure to ETS occurred more frequently at home, either singly (56%) or in combination with school/work and other places (75%). Exposed women were significantly younger, taller and lighter than those unexposed. Logistic regression on 20+ aged women showed that single-separated-widowed, workers, women living in a rental house, and women with a central forced air heating were significantly more exposed to ETS. Crowding index (n inhabitants/n rooms of the house) was significantly higher in those exposed. These results indicate that ETS exposure is quite frequent in Italian women and that some life-style factors (e.g. marital status or occupational status or some home characteristics), should be considered in the study of relationship between passive smoking and respiratory health.     

Trawler fuel exhaust and respiratory impairments: a cross-sectional pilot study among Indian fishermen working in informal sectors

Background:

An estimated half a billion people are engaged in fishing related occupations in India. Exposure to adulterated fuel exhaust is common among deep-sea fishermen, yet little is known about the potential impacts on the exposure to health.

Objective:

The aim of this study was to investigate whether fuel emission exposure was associated with increased respiratory impairments among fishermen who were occupationally exposed to fuel exhaust compared to fisherman occupationally unexposed to fuel exhaust.

Methods:

This cross-sectional study compared the prevalence of respiratory symptoms and lung function variables between 152 marine-water and 107 fresh water fishermen considering the use of fuel-driven trawlers. Data were obtained from questionnaires and computerized spirometer.

Results:

Fishermen exposed to trawler fuel exhaust reported more than double the number of respiratory symptoms compared to the unexposed fisherman (86.2 vs. 40.2%). They also had a significantly higher chance experiencing chronic cough (adjusted OR = 3.51, 95% confidence interval (CI) = 2.09–6.35), chronic phlegm (8.61, 4.76–15.97), and wheezing (4.29, 2.55–7.61) symptoms. Finally, there was a significant reduction of the ratio of mid portion of forced expiratory flow rate and forced vital capacity (FEF_25–75/FVC) in the exposed fishermen compared to the unexposed (0.84 vs. 0.73 second⁻¹, P = 0.015).

Conclusion:

Fuel exhaust may negatively impact on the respiratory health of Indian fishermen. More attention and surveillance of occupational health for fishermen in India is needed.