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Tuberculosis and indoor biomass and kerosene use in Nepal: a case-control study.

Environ Health Perspect. 2010 Apr;118(4):558-64.

Pokhrel AK, Bates MN, Verma SC, Joshi HS, Sreeramareddy CT, Smith KR.

''School of Public Health, University of California-Berkeley, Berkeley, California, USA.'

Background: In Nepal, Tuberculosis (TB) is a major problem. Worldwide, six previous epidemiologic studies have investigated whether indoor cooking with biomass fuel such as wood or agricultural wastes is associated with TB with inconsistent results.

Objectives: Using detailed information on potential confounders, we investigated the associations between TB and the use of biomass and kerosene fuels.

Methods: A hospital-based case-control study was conducted in Pokhara, Nepal. Cases (n = 125) were women, 20-65 years old, with a confirmed diagnosis of TB. Age-matched controls (n = 250) were female patients without TB. Detailed exposure histories were collected with a standardized questionnaire.

Results: Compared with using a clean-burning fuel stove (liquefied petroleum gas, biogas), the adjusted odds ratio (OR) for using a biomass-fuel stove was 1.21 confidence interval (CI), 0.48-3.05, whereas use of a kerosene-fuel stove had an OR of 3.36 (95% CI, 1.01-11.22). The OR for use of biomass fuel for heating was 3.45 (95% CI, 1.44-8.27) and for use of kerosene lamps for lighting was 9.43 (95% CI, 1.45-61.32).

Conclusions: This study provides evidence that the use of indoor biomass fuel, particularly as a source of heating, is associated with TB in women. It also provides the first evidence that using kerosene stoves and wick lamps is associated with TB. These associations require confirmation in other studies. If using kerosene lamps is a risk factor for TB, it would provide strong justification for promoting clean lighting sources, such as solar lamps.

Editor’s Summary: Tuberculosis (TB) is a major infectious cause of illness and death worldwide, and the majority of new cases and deaths occur in Asia and Africa. Results of previous epidemiologic studies of indoor cooking with biomass fuels (e.g., wood or agricultural waste) and TB have been inconsistent. Pokhrel et al (p. 558) investigated TB and the use of biomass and kerosene fuels in a case-control study in Nepal. Cases were women, 20-65 years of age, with a confirmed diagnosis of TB; age-matched controls were female patients without TB. The investigators found that TB was associated with the use of a biomass-fuel stove compared with a stove burning clean fuels (e.g., liquefied petroleum gas, biogas), and there were also associations with the use of a kerosene-fuel stove and with the use of biomass fuel for heating and kerosene lamps for lighting. The authors conclude that the use of indoor biomass fuel, particularly as a source of heating, is associated with TB in women. The authors also note that if the use of kerosene lamps can be confirmed as a risk factor for TB, there would be justification for promoting alternative lighting sources such as solar lamps.

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