Respiratory symptoms and associated factors among women exposed to biomass fuel smoke in Sri Lanka: cross sectional study
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20202968Keywords:
Biomass fuel, Wood, Respiratory symptoms, Chimney, KitchenAbstract
Background: Biomass fuel smoke is a leading cause of indoor air pollution. It is a known risk factor for respiratory diseases. This study was conducted to determine the prevalence of respiratory symptoms and associated factors among women exposed to biomass fuel smoke in Sri Lanka.
Methods: Women (n=600) were assessed using questionnaires to determine base line data, cooking fuel use, respiratory symptoms (MRC respiratory symptoms questionnaire) and diagnosed respiratory diseases. Kitchen characteristics were determined by direct observation. Sample frequencies were calculated. Logistic regression analysis was done to determine the associations.
Results: Majority (64.1%) were biomass fuel users. Their mean age was 47 years ±14 SD. Majority 99.2% were never smokers. Prevalence of cough, phlegm, cough and phlegm, wheeze, breathlessness and diagnosed asthma was 14%, 16%, 9.9%, 22%, 22.3%, and 6.3% respectively. Use of biomass fuel was related to any respiratory symptom (OR=1.9; p<0.05), cough (OR=1.9; p<0.05), phlegm (OR=2.0; p<0.05), cough and phlegm (OR=2.7; p<0.05), wheezing (OR=2.0; p<0.05) and breathlessness (OR=2.0; p<0.05). Use of biomass fuel in an outdoor kitchen was associated with cough (OR=2.8, p<0.05), phlegm (OR=4.6, p<0.05), cough and phlegm (OR=3.1, p<0.05) and breathlessness (OR=2.1, p<0.05). Use of biomass fuel in a kitchen with neither chimney nor windows was associated with phlegm (OR=2.9, p<0.05) and cough and phlegm (OR=3.0, p<0.05).
Conclusions: Use of biomass fuel for cooking in an outdoor kitchen and in a kitchen with neither chimney nor windows were positively associated with respiratory symptoms in non-pregnant women exposed to biomass fuel smoke in Sri Lanka.
References
Sood A. Indoor fuel exposure and the lung in both developing and developed countries: An update. Clin Chest Med. 2012;33(4):649-65.
World Health Organization. Household air pollution and health, 2020. Available at: https://www.who.int/news-room/fact-sheets/detail/
household-air-pollution-and-health. Accessed on 11 April 2020.
Department and Census and Statistics, Sri Lanka. Jana ha nivasa saṅgaṇanaya; 2012:2015.
World Health Organization. WHO guidelines for indoor air quality: household fuel combustion. Available at https://apps.who.int/iris/bitstream/
handle/10665/141496/9789241548885_eng.pdf?sequence=1. Accessed on 13 January 2020.
Ngahane MBH, Afane ZE, Chebu C, Mapoure NY, Temfack E, Nganda M, et al. Effects of cooking fuel smoke on respiratory symptoms and lung function in semi-rural women in Cameroon. Int J Occup Environ Health. 2015;21(1):61-5.
Kurmi OP, Semple S, Devereux GS, Gaihre S, Lam KBH, Sadhra S, et al. The effect of exposure to biomass smoke on respiratory symptoms in adult rural and urban Nepalese populations. Environ Health. 2014;13:92.
Ranathunga N, Perera P, Nandasena S, Sathiakumar N, Kasturiratne A, Wickremasinghe R. Effect of household air pollution due to solid fuel combustion on childhood respiratory diseases in a semi urban population in Sri Lanka. BMC Pediatr. 2019;19(1):306.
Aggarwal N, Deswal BS, Ray S, Pal V. An epidemiological study of chronic obstructive pulmonary disease among 35 years and above rural population of Gurugram, Haryana. Int J Community Med Public Health. 2019;6(5):2206.
Duque TC, Maldonado D, Padilla PR, Ezzati M, Viegi G. Biomass Fuels and Respiratory Diseases: A Review of the Evidence. Proceedings Am Thoracic Society. 2008;5(5):577-90.
Po JYT, Gerald FJM, Carlsten C. Respiratory disease associated with solid biomass fuel exposure in rural women and children: systematic review and meta-analysis. Thorax. 2011;66(3):232-9.
Shrestha IL, Shrestha SL. Indoor Air Pollution from Biomass Fuels and Respiratory Health of the Exposed Population in Nepalese Households. Int J Occupational Environmental Health. 2005;11(2):150-60.
Prasad R, Singh A, Garg R, Hosmane GB. Biomass fuel exposure and respiratory diseases in India. Bio Science Trends. 2012;6(5):219-28.
Alex PKGK, Baisil SAUS, Badiger S. Assessment of awareness and attitude of rural women towards ill-effects of indoor air pollution and their perception regarding alternate cooking fuel usage in Mangalore. Int J Community Med Public Health. 2018;5(9):4092-7.
Panigrahi A, Padhi BK. Chronic bronchitis and airflow obstruction is associated with household cooking fuel use among never-smoking women: a community-based cross-sectional study in Odisha, India. BMC Public Health. 2018;18(1):924.
Desalu OO, Adekoya AO, Ampitan BA. Risco aumentado de sintomas respiratórios e bronquite crônica em mulheres que utilizam biocombustíveis na Nigeria. J Bras Pneumol. 2010;36(4):441-6.
Behera D, Jindal SK. Respiratory Symptoms in Indian Women Using Domestic Cooking Fuels. Chest. 1991;100(2):385-8.
Sidhu KM, Ravindra K, Mor S, John S, Aggarwal AN. Respiratory Health Status of Rural Women Exposed to Liquefied Petroleum Gas and Solid Biomass Fuel Emissions. Air Soil Water Res. 2019;12:1-8.
Alim MDA, Sarker MAB, Selim S, Karim MDR, Yoshida Y, Hamajima N. Respiratory involvements among women exposed to the smoke of traditional biomass fuel and gas fuel in a district of Bangladesh. Environ Health Prev Med. 2014;19(2):126-34.
Akhtar T, Ullah Z, Khan MH, Nazli R. Chronic Bronchitis in Women Using Solid Biomass Fuel in Rural Peshawar, Pakistan. Chest. 2007;132(5):1472-5.
Bruce N, Padilla PR, Albalak R. Indoor air pollution in developing countries: a major environmental and public health challenge. Bulletin of the World Health Organization; 2000. Available at: https://www.who.int/bulletin/archives/78(9)1078.pdf. Accessed on 21 February 2020.
Fullerton DG, Bruce N, Gordon SB. Indoor air pollution from biomass fuel smoke is a major health concern in the developing world. Trans R Soc Trop Med Hyg. 2008;102(9):843-51.
Launois C, Barbe C, Bertin E, Nardi J, Perotin JM, Dury S, et al. The modified Medical Research Council scale for the assessment of dyspnea in daily living in obesity: a pilot study. BMC Pulmonary Medicine. 2012;12(1):61.
Woodruff PG, Barr RG, Bleecker E, Christenson SA, Couper D, Curtis JL, et al. Clinical Significance of Symptoms in Smokers with Preserved Pulmonary Function. N Engl J Med. 2016;374(19):1811-21.
Madegedara D, Samankantha S, Nandadewe D, Wijethilake T, Amerasinghe K, Egodawela N. An analysis of respiratory health in a cohort of villagers exposed to biomass fuel. Eur Respir J. 2014;44(58).
Nightingale R, Lesosky M, Flitz G, Rylance SJ, Meghji J, Burney P, et al. Noncommunicable Respiratory Disease and Air Pollution Exposure in Malawi (CAPS). A Cross-Sectional Study. Am J Respir Crit Care Med. 2019;199(5):613-21.
Fullerton DG, Suseno A, Semple S, Kalambo F, Malamba R, White S, et al. Wood smoke exposure, poverty and impaired lung function in Malawian adults. Int J Tuberc Lung Dis. 2011;15(3):391-8.
Pathak U, Kumar R, Suri TM, Suri J, Gupta N, Pathak S. Impact of biomass fuel exposure from traditional stoves on lung functions in adult women of a rural Indian village. Lung India. 2019;36(5):376-83.
Kurmi OP, Devereux GS, Smith WCS, Semple S, Steiner MFC, Simkhada P, et al. Reduced lung function due to biomass smoke exposure in young adults in rural Nepal. Eur Respir J. 2013;41(1):25-30.
Regalado J, Padilla PR, Sansores R, Ramirez PJI, Brauer M, Pare P, et al. The Effect of Biomass Burning on Respiratory Symptoms and Lung Function in Rural Mexican Women. Am J Respir Crit Care Med. 2006;174(8):901-5.
Clark ML, Peel JL, Burch JB, Nelson TL, Robinson MM, Conway S, et al. Impact of improved cook stoves on indoor air pollution and adverse health effects among Honduran women. Int J Environmental Health Res. 2009;19(5):357-68.
Diaz E, Bruce N, Pope D, Lie RT, Díaz A, Arana B, et al. Lung function and symptoms among indigenous Mayan women exposed to high levels of indoor air pollution. Int J Tuberc Lung Dis. 2007;11(12):1372-9.
Deka P, Hoque RR. Chemical characterization of biomass fuel smoke particles of rural kitchens of South Asia. Atmospheric Environment. 2015;108:125-32.
Koksal H, Saygi A, Sariman N, Alici E, Yurtlu S, Yilmaz H, et al. Evaluation of Clinical and Functional Parameters in Female Patients with Biomass Smoke Exposure. Respir Care; 2012. Available at: http://www.ingentaconnect.com/ content/jrcc/rc/pre-prints/rc01772r3koksal. Accessed on 17 May 2020.
Amerasekera RM. Proven interventions to reduce indoor air pollution due to cooking with biomass. Air That We Breath, First National Symposium on Air Resource Management in Colombo, Sri Lanka; 2004.
Sharma D, Jain S. Impact of intervention of biomass cook stove technologies and kitchen characteristics on indoor air quality and human exposure in rural settings of India. Environ Int. 2019;123:240-55.
Elledge MF, Phillips MJ, Thornburg VE, Everett KH, Nandasena S. A Profile of Biomass Stove Use in Sri Lanka. Int J Environ Res Public Health. 2012;9(4):1097-110.
Nandasena S, Wickremasinghe R, Kasturiratne A, Wimalasiri U, Tipre M, Larson R, et al. Particulate Matter fractions and kitchen characteristics in Sri Lankan households using solid fuel and LPG. Epidemiology; 2018. Available at: http://biorxiv.org/lookup/doi/10.1101/461665. Accessed on 13 May 2020.
Vliet VEDS, Asante K, Jack DW, Kinney PL, Whyatt RM, Chillrud SN, et al. Personal exposures to fine particulate matter and black carbon in households cooking with biomass fuels in rural Ghana. Environ Res. 2013;127:40-8.
Shubhankar B, Ambade B. Health Impacts of Indoor Air Pollution of PM10 Size from Household Cooking Activities. J Basic Applied Engineering Res. 2016;3(1):35-40.
Wijesinghe P, Palihawadana P, Alwis DS, Samaraweera S. Annual risk of tuberculosis infection in Sri Lanka: a low prevalent country with a high BCG vaccination coverage in the South-East Asia Region. WHO South-East Asia J Public Health. 2013;2(1):34.
