Effect of household air pollution due to solid fuel combustion on childhood respiratory diseases in a semi urban population in Sri Lanka

Abstract

Background Household air pollution from combustion of solid fuels for cooking and space heating is one of the most important risk factors of the global burden of disease. This study was aimed to determine the association between household air pollution due to combustion of biomass fuel in Sri Lankan households and self-reported respiratory symptoms in children under 5 years. Methods A prospective study was conducted in the Ragama Medical Officer of Health area in Sri Lanka. Children under 5 years were followed up for 12 months. Data on respiratory symptoms were extracted from a symptom diary. Socioeconomic data and the main fuel type used for cooking were recorded. Air quality measurements were taken during the preparation of the lunch meal over a 2-h period in a subsample of households. Results Two hundred and sixty two children were followed up. The incidence of infection induced asthma (RR = 1.77, 95%CI;1.098–2.949) was significantly higher among children resident in households using biomass fuel and kerosene (considered as the high exposure group) as compared to children resident in households using Liquefied Petroleum Gas (LPG) or electricity for cooking (considered as the low exposure group), after adjusting for confounders. Maternal education was significantly associated with the incidence of infection induced asthma after controlling for other factors including exposure status. The incidence of asthma among male children was significantly higher than in female children (RR = 1.17; 95% CI 1.01–1.37). Having an industry causing air pollution near the home and cooking inside the living area were significant risk factors of rhinitis (RR = 1.39 and 2.67, respectively) while spending less time on cooking was a protective factor (RR = 0.81). Houses which used biomass fuel had significantly higher concentrations of carbon monoxide (CO) (mean 2.77 ppm vs 1.44 ppm) and particulate matter 2.5 (PM 2.5 ) (mean 1.09 mg/m 3 vs 0.30 mg/m 3 ) as compared to houses using LPG or electricity for cooking. Conclusion The CO and PM 2.5 concentrations were significantly higher in households using biomass fuel for cooking. There was a 1.6 times higher risk of infection induced asthma (IIA) among children of the high exposure group as compared to children of the low exposure group, after controlling for other factors. Maternal education was significantly associated with the incidence of IIA after controlling for exposure status and other variables.

Prevalence of pneumonia and its associated factors among under-five children in East Africa: a systematic review and meta-analysis

“…Higher odds of pneumonia were observed in underfive children whose family uses wood as a source of fuel. This result was in line with studies conducted in India [57], and Sri Lanka [58]; and with systematic reviews conducted in Low and Middle income countries [59], and Africa, China and Latin America [60]. It was also consistent with a global review conducted by Jackson et al [61].…”

Prevalence of pneumonia and its associated factors among under five children in East Africa. Meta-analysis and systemic review

“…Higher odds of pneumonia were observed in under-ve children whose family uses wood as a source of fuel. This result was in line with studies conducted in India (52), and Sri Lanka (53); and with systematic reviews conducted in Low and Middle income countries (54), and Africa, China and Latin America (55). It was also consistent with a global review conducted by Jackson et al (56).…”

“…Holding children on back while cooking foods was another factor found to be signi cantly associated with pneumonia. This association might be due to the reason that cooking foods in living rooms will cause indoor air pollution and holding a child on back while cooking foods can increase the probability of inhaling smokes and food vapors (steams) which in turn will increase the risk of acquiring pneumonia by altering the structure and function of the respiratory tract (53,58).…”

Review of air pollution studies in Sri Lanka

“…Another study (Ranathunga et al, 2019) reports on the effect of firewood cooking on the respiratory illnesses of children under 5 years where simultaneous air quality measurements were also carried out. It was found that infection induced asthma was significantly higher in homes using biomass and kerosene as fuels for cooking when compared to the use of LPG for cooking.…”