The goal of this study was to assess the impact of improved stoves, house ventilation, and child location on levels of indoor air pollution and child exposure in a rural Guatemalan population reliant on wood fuel. The study was a random sample of 204 households with children less than 18 months in a rural village in the western highlands of Guatemala. Socio-economic and household information was obtained by interview and observation. Twentyfour hour carbon monoxide (CO) was used as the primary measure of kitchen pollution and child exposure in all homes, using Gastec diffusion tubes. Twenty-four hour kitchen PM 3.5 was measured in a random sub-sample (n ¼ 29) of kitchens with co-located CO tubes. Almost 50% of the homes still used open fires, around 30% used chimney stoves (planchas) mostly from a large donor-funded programme, and the remainder of homes used various combinations including bottled gas and open fires. The 24-h kitchen CO was lowest for homes with self-purchased planchas: mean (95% CI) CO of 3.09 ppm (1.87-4.30) vs. 12.4 ppm (10.2-14.5) for open fires. The same ranking was found for child CO exposure, but with proportionately smaller differentials (Po0.0001). The 24-h kitchen PM 3.5 in the sub-sample showed similar differences (n ¼ 24, Po0.05). The predicted child PM for all 203 children (based on a regression model from the sub-sample) was 375 mg/m 3 (270-480) for self-purchased planchas and 536 mg/m 3 (488-584) for open fires. Multivariate analysis showed that stove/fuel type was the most important determinant of kitchen CO, with some effect of kitchen volume and eaves. Stove/fuel type was also the key determinant of child CO, with some effect of child position during cooking. The improved stoves in this community have been effective in reducing indoor air pollution and child exposure, although both measures were still high by international standards. Large donor-funded stove programmes need to aim for wider acceptance and uptake by the local families. Better stove maintenance is also required.
We estimated the prevalence and severity of asthma, and the association with cooking on open wood fires, as preparation for a large-scale randomized field trial on effects of indoor air pollution and child health. This is one of the first systematic studies of asthma and indoor wood-smoke pollution and to our knowledge the first asthma study in a purely indigeneous population in Latin America. The mothers of 1058 children aged 4-6 years were interviewed, using the standardized ISAAC (International Study of Asthma and Allergies in Childhood) procedures and questionnaire. The study population is a Mam-speaking (Maya), indigenous group living at relatively high altitude (2000 m) in Western Guatemalan Highlands. We found that asthma prevalence is low among indigenous children in Gautemala, compared to other populations in Latin America. Only 3.3% of the children reported wheezing symptoms in the last 12 months, and 72% wheezing symptoms ever. The majority of the current wheezers had at least one of the criteria for severe asthma. The prevalence of all the symptoms of asthma was higher in children from households that used open fires compared to improved stoves with chimneys. In a logistic regression model, use of open fire for cooking was a significant risk factor for a number of asthma symptoms, with odds ratios varying from 2.0 to 3.5. Among the different cooking technologies (1Fimproved stove with chimney, 2Fmixture of gas and open fire, 3Fopen fire) trends of higher prevalence with more pollution was found for some of the symptoms. Hence use of open fire for cooking, may be an important risk factor for asthma symptoms and severity.
Background-The development of asthma seems to be influenced by the adoption of a Western lifestyle. A study was undertaken to assess the importance of indoor environmental factors in Nepal where the lifestyle and home environment diVer from that in the West. Methods-The home environment of 121 schoolchildren with asthma and 126 controls aged 11-17 years was studied. The homes of all participants were investigated and the children and their mothers were interviewed using a standardised questionnaire. Cases and controls were identified from an ISAAC (International Study of Asthma and Allergy in Childhood) based population study of 2330 schoolchildren in Kathmandu, Nepal. Results-Keeping cattle inside the house during the night was related to a lower risk for having asthma (adjusted odds ratio (OR) 0.2 (95% CI 0.1 to 0.5)) while there was no association between asthma and cattle kept outside. Asthma was associated with cigarette smoking by two or more family members (OR 1.9 (95% CI 1.0 to 3.9)) and with the domestic use of smoky fuels (OR 2.2 (95% CI 1.0 to 4.5)). In analyses stratified by sex, passive smoking and the use of smoky fuels were significantly associated with asthma only in boys. Conclusions-The risk of asthma in Nepalese children was lower in subjects exposed to cattle kept inside the house and higher in subjects exposed to passive smoking and indoor use of smoky fuels. Childhood exposure to microorganisms or allergens from cattle may protect against the development of atopic disease. (Thorax 2001;56:477-481) Keywords: asthma; domestic animals; smoky fuels; passive smoking; infection hypothesis; microbial stimulation Epidemiological studies suggest that the development of asthma may be influenced by the adoption of a Western lifestyle.1 2 The International Study on Asthma and Allergies in Childhood (ISAAC) showed a significant worldwide variation in the prevalence of symptoms of asthma, with the highest prevalence in English speaking Western countries and the lowest prevalence in Eastern Europe and Asia. In the Western world diVerent populations may be exposed to risk factors for asthma in a similar way. Aetiological patterns may be more evident when comparisons are made between more diVerent cultures. A study was undertaken to assess the importance of indoor environmental factors potentially relevant for asthma in Nepal, a country where the lifestyle and home environment is diVerent from that in the West.Atopic diseases are reported to be more common in children exposed to animal dander than in those not exposed.4 5 On the other hand, findings from the European Community Respiratory Health Survey indicate that dog keeping in early childhood protects against adult atopy.6 A study of Swedish children revealed less asthma and allergic rhinitis in children who had a pet during their first year of life.7 Furthermore, recent studies of allergy in a farm environment provide evidence of less hay fever and asthma among children of farmers. [8][9][10] In Nepal a large proportion of the population are...
A simple replacement of foam mattresses with spring mattresses may reduce the exposure to house-dust-mite allergens.
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