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Health risk caused by domestic smoke by Dr M R Pandey


Table of Contents

Boiling Point
Front cover of Boiling Point issue 40
Issue 40 (1998) Household energy and health
ArticleHealth risk caused by domestic smoke
AuthorDr M.R. Pandey


Santé humaine et émissions de fumée domestique.

L'auteur souligne que dans les zones rurales des pays en développement, la pollution domestique résultant des bio-combustibles a un impact significatif et croissant sur la santé. L'auteur identifie quatre effets majeurs sur la santé dûs aux fumées: les maladies respiratoires, les pertes de poids à la naissance, les cancers et les maladies des yeux.

Indoor air pollution in the past was generally considered to be a problem associated with tobacco smoking or in occupational settings dominated by men. In rural locations in developing countries, indoor air pollution from burning biomass fuels is now recognized as an important and widespread problem. Evidence from a number of countries, including Nepal (1), India (2), Papua New Guinea (3,4,) and Kenya (5) suggests that domestic fires for cooking and heating purpose can cause significant pollution.

About half the world's households cook daily with biomass fuels where, for all or part of the year, these pollutants are released from stoves in poorly ventilated kitchens. The highest exposures are probably experienced by women, infants and young children. Measured levels of air pollution in these houses greatly exceed both indoor and outdoor air concentrations found in developed countries (6). The pollutants found in biomass smoke contain particles which are breathed into the lungs, carbon monoxide, nitrogen oxides, formaldehyde, and hundreds of other organic compounds.

The main health effects of domestic smoke pollution are:
  • Respiratory diseases
  • Low birth weight
  • Cancer
  • Eye problems

[top] [end]Respiratory diseases

In June 1984, the World Health Organization announced that respiratory diseases had become the chief cause of death in developing countries (7). Domestic smoke pollution is an important contributing factor for two major classes of respiratory diseases, which are:
  • Acute respiratory infections (ARI) among infants and children
  • Chronic obstructive lung disease (COLD) in adults.
Figure 1: Young children stay close to their mothers as they do the cooking (ITDG)
Figure 1: Young children stay close to their mothers as they do the cooking (ITDG)


[top] [end]Acute respiratory infection (ARI) among infants and children

Out of about 15 million children under five years of age who die in the world each year, approximately one third die from ARI. Most of the deaths from acute respiratory infections are caused by pneumonia (8,9). The overwhelming majority of these deaths occur in developing countries.

Figure 2: Percentage of population suffering from chronic bronchitis
Figure 2: Percentage of population suffering from chronic bronchitis


Case studies on ARI in Nepal, Zimbabwe, and Gambia

The Nepal study examined about 240 rural children, aged under two years, each week for 6 months to see if they were suffering from ARI (10). A strong relationship was found between the hours per day which mothers said the children stayed by the fire and the number of cases of moderate and severe ARI.

In Zimbabwe, 244 children, aged under three years reporting at the hospital with ARI were compared to 500 similar children reporting to a Well Baby Clinic (12). Presence of an open wood-fire was found to be a significant ARI risk factor.

In a study of 500 children in Gambia, girls under 5 years carried on their mothers' backs during cooking (in smoky cooking huts) were found to have a six times higher risk of ARI. This was much higher than the risk involved in parents smoking. There was no significant risk, however, for young boys (13).

These studies suggest a link, but if we are to answer the question 'How much can we reduce ARI by reducing indoor air pollution from biomass combustion?' conclusively, further studies will be needed.

Biomass fuels produce high nitrogen dioxide levels as well as other toxic pollutants, and it is probable that these pollutants have a range of effects on the child's respiratory defence mechanisms. Currently available information justifies measures to reduce exposure by technologies such as improved stoves. These should be included as part of rural energy, housing, and health programmes.

[top] [end]Chronic obstructive lung disease (COLD) in adults

Chronic bronchitis and chronic obstructive lung disease present doctors all over the world with some of their most frequent problems. Early studies done in Papua New Guinea (14) showed a possible link between domestic smoke pollution and chronic bronchitis.

Case study of chronic bronchitis in Nepal

A study in Nepal determined the distribution and magnitude of this disease in different geographical regions (15). Four different sites were selected;
  • urban Kathmandu
  • the villages of Sundarijal and Bhadrabas in a rural, hilly region
  • the lowland village of Parasauni
  • Chandannath, a village in the mountainous region.
The percentage of the population suffering from chronic bronchitis at different sites is shown in Figure 2.

The large number of cases of chronic bronchitis in both women and men contrasts with the findings of most other studies which show less cases among women (16). This is because the cause for men is smoking whilst, in this case, women are exposed more to domestic smoke pollution for long hours (Figure 3). In Sundarijal and Bhadrabas (17) and in the urban Kathmandu and Terai sites, a link between prevalence of this disease and hours of exposure to domestic smoke pollution was found.
Figure 3: Women are exposed to smoke for several hours each day (ITDG)
Figure 3: Women are exposed to smoke for several hours each day (ITDG)


[top] [end]Domestic smoke pollution and respiratory function among women



Case study on lung function in Nepal

A study in Nepal looked at the effect of domestic smoke pollution on how well the lungs functioned in women aged 30-44 years. They were divided into six groups, each containing 25 women. They were divided up further into: smokers and non-smokers, and how long they were exposed to household smoke (0-1.9 hrs, 2-3.9 hrs and 4-6 hours).

All the tests were performed in a standard way and it was checked that no other variation in the groups such as weight, etc. could be responsible for any differences measured.

In this particular study it was found that with increasing exposure to smoke, the lungs functioned less well amongst smokers but did not affect non-smokers appreciably (18). A study in Ladakh (19) has demonstrated an association between increase in exposure to pollution on individual people between summer and winter, and a fall of about 10% in lung function over the same period. Malik (20) in India also found a link between household smoke and chronic bronchitis. These studies indicated that even non-smoking women who have cooked using biomass for many years suffer more from chronic bronchitis than those who have not.

[top] [end]Low birth weight

There are no recorded studies on the effects of indoor cooking smoke on birth weight. However, there is substantial evidence to suggest an important impact. The major effect is thought to be the increased carbon monoxide content in the kitchen, which gets into the mother's bloodstream and affects the way the oxygen in the blood is delivered to the fetus. Given the well-documented effects of mothers' cigarette smoking on fetal growth, smoke-filled kitchens are likely to produce a low birth weight, or may lead to infant death before or at the time of birth. A second reason for low birth weight may be that the pregnant woman is more likely to suffer from lung infections that in turn reduce her appetite and food intake. At the same time, to fight the infection, her nutritional requirements increase, so less nutrition is delivered to the fetus, and there is a reduced oxygen uptake in the bloodstream.

[top] [end]Cancer

There are many chemicals in bio-mass smoke which are known to cause cancer in laboratory animals and are found in mixtures known to cause cancer in humans (21). In the 1970s, based on a small study in Kenya, it was thought that cancer in the nose and throat might be associated with biomass smoke, (22) but newer studies in Malaysia (23) and Hong Kong (24) have failed to confirm this. A recent study from Osaka, Japan (25) found that women cooking with straw or wood fuel up to 30 years of age have an 80% increased chance of having lung cancer in later life. In contrast to biomass, there are many studies of the air pollution levels and health impacts of cooking with coal on open stoves, almost all done and published in China, where coal use for cooking is common (26). A range of effects are found, including quite strong associations with lung cancer.

[top] [end]Eye problems

It is quite obvious to everybody that domestic smoke pollution causes minor irritations of the eyes and upper respiratory tract. It can cause conjunctivitis. It has been suggested that it may also be responsible for cataracts, but there has been no scientific evidence for the same.

[top] [end]References

  1. Pandey, M.R., Smith, K.R., Bolejo, J.S.M. and Wafula, E.M. Indoor air pollution in developing countries and acute respiratory infection in children. Lancet, 1989, Feb. 28, 427- 429.
  2. Behera D. Dash S, Malik S K. Blood carboxyhemoglobin levels following acute exposure to smoke and biomass fuel. Indian J Med Res 1988; 88: 522-524.
  3. Anderson H R. Chronic lung disease in the Papua New Guinea Highlands. Thorax 1979; 34: 647-653.
  4. Cleary G J and Blackburn C R B. Air pollution in native huts in the highlands of New Guinea. Arch Env Health 1968; 17: 785-794.
  5. Boleij J S, Ruigewaard P, Hoek F, Thairu H, Wafula E, Onyango F, De Koning H. Domestic air pollution from biomass burning in Kenya. Atmospheric Environment 1989; 23: 1677-1681.
  6. Smith, K.R. Biofuels, air pollution and health: A global review, New York; Plenum, 1987.
  7. World Health Organization WHO annual statistics report reveals major public health killers. Geneva: WHO press release WHO/8, June 21, 1984.
  8. Editorial Note, Acute Respiratory Infections in under fives, 15 million deaths a year. The Lancet Sept. 28, 1985; 699-700.
  9. World Health Organization, Global Medium-Term programme, Acute Respiratory Infections document TRI/ARI/MTP/83.1. Geneva, 1983.
  10. Pandey, M.R. et al. (1989b) Domestic smoke pollution and acute respiratory infections in a rural community of the hill region of Nepal. Environment International, 15: 337-340.
  11. Collings D.A. et al. (1990) Indoor wood smoke pollution causing lower respiratory disease in children. Tropical Doctor, 20: 151-155.
  12. Armstrong, J.R.M. & Campbell, H. (1991) Indoor air pollution
  13. Exposure and lower respiratory infection in young Gambian children. Int. J. Epidemiology, 20(2): 424-428.
  14. Anderson H.R. chronic lung disease in the Papua New Guinea Highlands. Thorax 1979; 34: 647-653.
  15. Pandey, M.R., Basnyat, B. and Neupane, R.P. Chronic bronchitis and cor pulmonale in Nepal. Monograph: Mrigendra Medical Trust, March 1988.
  16. Pandey, M.R. Prevalence of chronic bronchitis in a rural community of the hill region of Nepal. Thorax, 1984; 39: 331-36.
  17. Pandey, M.R. Domestic smoke pollution and chronic bronchitis in a rural community of the hill region of Nepal. Thorax, 1984; 39: 337-39.
  18. Pandey, M.R., Regmi, H.N., Neupane, R.P., Gautam, A.G., Bhandari, D.P. Domestic smoke pollution and respiratory function in rural Nepal. Tokai J. Exp. Clin. Med. 1985; 10, 4, 471-481.
  19. Narboo T, Yahya M, Bruce N G, Heady J A, Ball K P. Domestic pollution and respiratory illness in a Himalayan village. Int J. Epidemiol 1990.
  20. Malik, S.K. (1985) Exposure to domestic cooking fuels and chronic bronchitis. Indian J. of Chest Disease and Allied Sciences, 27: 171-174.
  21. Cooper, J.A. (1980) Environmental impact of residential wood combustion emissions and its implications. Journal of Air Pollution Control Association, 30: 855-861.
  22. Clifford. P. (1972) Carcinogens in the nose and throat. In: Proceedings of the Royal Society of Medicine, 65: 682-686.
  23. Armstrong, R.W. et al. (1978) Self-specific environments associated with nasopharyngeal carcinoma in Selangor, Malaysia. Social Science and Medicine, 12D: 149-156.
  24. Yu, M.C. et al. (1985) Epidemiology of nasopharyngeal carcinoma in Malaysia and Hong Kong. National Cancer Institute Monograph 69: 203-207.
  25. Sobue, T. (1990) Association of indoor air pollution and lifestyle with lung cancer in Osaka, Japan. Int. J. of Epidemiology, 19, Supplement 1: s62-s66.
  26. Hong, C.J. (1991) Health aspects of domestic use of biomass and coal in China. WHO/PEP 92.3B

[top] [end]Contents: Boiling Point 40: Household energy and health

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Household energy, smoke and health - Smoke from biomass and its effects on infants - Health risk caused by domestic smoke - Emissions from high altitude stoves - a case study in Nepal - Biomass smoke and ill-health in India - preliminary results from a national survey - Global network for the health effects of environmental air pollution - Fuels, stoves and indoor air pollution in Jaracuaro, Mexico - Redesign of liquified petroleum gas stove for the blind - How many of these improvements are in your stoves programme - Participatory Technology Development in stove manufacture - a case study - Renewable energy sources in Nigeria- Efficient household energy use in Uttara Kannada District, Karnataka - Research into cooking and heating applications of down-draught stoves - Comparing forestry wood species for the charcoal supply of Antananarivo city, Madagascar



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