Academic journal article Environmental Health Perspectives

The Health Impacts of Exposure to Indoor Air Pollution from Solid Fuels in Developing Countries: Knowledge, Gaps, and Data Needs

Academic journal article Environmental Health Perspectives

The Health Impacts of Exposure to Indoor Air Pollution from Solid Fuels in Developing Countries: Knowledge, Gaps, and Data Needs

Article excerpt

Globally, almost 3 billion people rely on biomass (wood, charcoal, crop residues, and dung) and coal as their primary source of domestic energy. Exposure to indoor air pollution (IAP) from the combustion of solid fuels is an important cause of morbidity and mortality in developing countries. In this paper, we review the current knowledge on the relationship between IAP exposure and disease and on interventions for reducing exposure and disease. We take an environmental health perspective and consider the details of both exposure and health effects that are needed for successful intervention strategies. We also identify knowledge gaps and detailed research questions that are essential in successful design and dissemination of preventive measures and policies. In addition to specific research recommendations, we conclude that given the interaction of housing, household energy, and day-to-day household activities in determining exposure to indoor smoke, research and development of effective interventions can benefit tremendously from integration of methods and analysis tools from a range of disciplines in the physical, social, and health sciences. Key words: developing countries, exposure assessment, exposure--response relationship, household energy, indoor air pollution, intervention, public health. Environ Health Perspect 110:1057-1068 (2002). [Online 10 September 2002]

http://ehpnet1.niehs.nih.gov/docs/ 2002/110p 1057-1068ezzati/abstract.html

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Globally, almost 3 billion people rely on biomass (wood, charcoal, crop residues, and dung) and coal as their primary source of domestic energy (1,2). Biomass accounts for more than one-half of domestic energy in many developing countries and for as much as 95% in some lower income ones (1,3). There is also evidence that in some countries the declining trend of household dependence on biomass has slowed, or even reversed, especially among poorer households (2,4).

Biomass and coal smoke contain a large number of pollutants and known health hazards, including particulate matter, carbon monoxide, nitrogen dioxide, sulfur oxides (mainly from coal), formaldehyde, and polycyclic organic matter, including carcinogens such as benzo[a]pyrene (5-9). Exposure to indoor air pollution (IAP) from the combustion of solid fuels has been implicated, with varying degrees of evidence, as a causal agent of several diseases in developing countries, including acute respiratory infections (ARI) and otitis media (middle ear infection), chronic obstructive pulmonary disease (COPD), lung cancer (from coal smoke), asthma, cancer of the nasopharynx and larynx, tuberculosis, perinatal conditions and low birth weight, and diseases of the eye such as cataract and blindness (9-12).

Most current epidemiologic studies on the health impacts of exposure to IAP in developing countries have focused on the first three of the above diseases (9,10). Increasing evidence of the role of maternal exposure to IAP as a risk factor for low birth weight (13) illustrates that perinatal/neonatal conditions, in particular low birth weight, are also likely to have large and long-term health effects and to be an important source of burden of disease due to this risk factor. Given current quantitative knowledge, however, acute lower respiratory infections (ALRI) and COPD are the leading causes of mortality and burden of disease due to exposure to IAP from solid fuels.

Conservative estimates of global mortality due to IAP from solid fuels show that in 2000, between 1.5 million and 2 million deaths were attributed to this risk factor (14,15). This accounts for approximately 4-5% of total mortality worldwide. Approximately 1 million of these deaths were due to childhood ALRI, with the remainder due to other causes, dominated by COPD and then lung cancer, among adult women (14,15). Burden of disease is calculated as the number of years lost because of premature mortality plus the number of years lived with disability due to a disease, with appropriate disability weights (16). …

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