Respiratory involvements among women exposed to the smoke of traditional biomass fuel and gas fuel in a district of Bangladesh

Exploring the cooking energy biomass and its impact on women's health and quality of life in rural households: a micro-environmental study from West Bengal in India

Exposure to household air pollutants has become a significant environmental health concern in developing nations. This study aimed to understand the growing energy consumption within households, particularly for cooking, and its impact on women's health in rural areas. We conducted real-time monitoring of ambient particulate matter (PM2.5) and carbon monoxide (CO) levels in 61 rural kitchens in the Medinipur and Jhargram districts of West Bengal, India. Additionally, we calculated the Standard Living Index (SLI) based on socio-demographic factors from 540 households. Our analyses using ANOVA and chi-square methods revealed significant effects of cooking fuel types and locations on various health indicators among women. Eye irritation was prevalent across all fuel types, followed by shortness of breath (33%), coughing (22%), and dizziness (21%). Alarmingly, nearly half (48%) of children under five consistently accompanied their mothers during cooking, exposing them to health risks. Indoor air pollution, particularly from traditional fuels like fuelwood, cow dung cakes, and leaves, poses a grave threat to families. These fuels emit considerable amounts of PM2.5 and CO, with levels reaching as high as 565 µg/m3 and 12.5 ppm, respectively, leading to respiratory and cardiovascular complications. Clean cooking fuel users, such as those using LPG, reported improved quality of life scores across physical, psychological, social, and environmental categories. This study highlights the urgent need to transition to cleaner cooking fuels to mitigate adverse health effects on women and children in rural households.

Evaluating the properties that affect the quality of the charcoal product, determining the limits of toxic emissions during combustion, and studying their impact on human health

This research focuses on examining the potential impact of charcoal briquettes and lumps on human health due to the emissions they release, and verifying their quality standards. Quality assessment was conducted using a device capable of measuring toxic gases to identify contaminants from various sources such as biomass, synthetic resins, coal, metals, and mineral matter. Toxicity assessments were carried out on five types of briquettes and two varieties of lump charcoal. All charcoal samples were subjected to elemental analysis (SEM/EDAX), including the examination of Ca, Al, Cr, V, Cu, Fe, S, Sr, Si, Ba, Pb, P, Mn, Rb, K, Ti, and Zn. The results showed that burning lump charcoal had toxicity indexes ranging from 2.5 to 5, primarily due to NOx emissions. Briquettes, on the other hand, exhibited higher toxicity indices between 3.5 and 6.0, with CO2 being the main contributor to toxicity. The average 24-h CO content of all charcoal samples exceeded the World Health Organization's 24-h Air Quality Guideline of 6.34 ppm, with a measurement of 37 ppm. The data indicates that most of the products tested did not meet the prevailing quality standard (EN 1860-2:2005 (E) in Appliances, solid fuels and firelighters for barbecuing-Part 2: Barbecue charcoal and barbecue charcoal briquettes-Requirements and test method, 2005), which specifies a maximum of 1% contaminants, with some products containing as much as 21% impurities. The SEM analysis revealed irregularly shaped grains with an uneven distribution of particles, and the average particle size distribution is quite broad at 5 μm. Malaysia Charcoal had the highest calorific value at 32.80 MJ/Kg, with the value being influenced by the fixed carbon content-higher carbon content resulting in a higher calorific value.

Assessment of the association between health problems and cooking fuel type, and barriers towards clean cooking among rural household people in Bangladesh

BACKGROUND

In low- and middle-income countries, households mainly use solid fuels like wood, charcoal, dung, agricultural residues, and coal for cooking. This poses significant public health concerns due to the emission of harmful particles and gases. To address these issues and support Sustainable Development Goals (SDGs), adopting cleaner cooking fuels like electricity and gas are acknowledged as a viable solution. However, access to these cleaner fuels is limited, especially in rural areas.

METHODS

This study conducted a face-to-face survey with 1240 individuals in rural Bangladesh to explore the link between health issues and cooking fuel type, as well as barriers to transitioning to clean cooking. Using a convenient sampling technique across four divisions/regions, the survey gathered socio-demographic and health data, along with information on clean cooking barriers through a semi-structured questionnaire. Binary and multivariable logistic regression analyses were then employed to identify significant associations between cooking fuel type and health problems.

RESULTS

The study revealed that a majority of participants (73.3%) relied on solid fuel for cooking. The use of solid fuel was significantly correlated with factors such as lower education levels, reduced family income, location of residence, and the experience of health issues such as cough, chest pressure while breathing, eye discomfort, diabetes, asthma, and allergies. Economic challenges emerged as the foremost obstacle to the adoption of clean cooking, accompanied by other contributing factors.

CONCLUSION

The use of solid fuel in rural Bangladeshi households poses substantial health risks, correlating with respiratory, eye, cardiovascular, and metabolic issues. Lower education and income levels, along with specific residential locations, were associated with higher solid fuel usage. Economic challenges emerged as the primary obstacle to adopting clean cooking practices. These findings emphasize the need for implementing strategies to promote clean cooking, address barriers, and contribute to achieving Sustainable Development Goal targets for health and sustainable energy access in Bangladesh.

Exploring the links between indoor air pollutants and health outcomes in South Asian countries: a systematic review

Indoor air pollution (IAP) has adverse effects on the health of people, globally. The objective of this systematic review was to present the range of health problems studied in association with indoor air pollutants in South Asian countries. We searched five databases, including PubMed, Web of Science, Scopus, Google Scholar, and CAB Direct for articles published between the years 2000 and 2020. We retrieved 5,810 articles, out of which we included 90 articles in our review. Among South Asian countries, only five countries have published results related to relationship between indoor air pollutants and adverse health conditions. All studies have shown adversity of indoor air pollutants on human's health. We found indoor solid fuel burning as a key source of indoor air pollution in the included studies, while women and children were most affected by their exposure to solid fuel burning. More than half of the studies accounted particulate matter responsible for indoor air pollution bearing negative health effects. In the included studies, eyes and lungs were the most commonly affected body organs, exhibiting common symptoms like cough, breathing difficulty and wheezing. This might have developed into common conditions like respiratory tract infection, chronic obstructive pulmonary diseases and eye cataract. In addition to promote research in South Asian countries, future research should focus on novel digital ways of capturing effects of indoor air pollutants among vulnerable segments of the population. As a result of this new knowledge, public health agencies should develop and test interventions to reduce people's exposure levels and prevent them to develop adverse health outcomes.

The prevalence of rheumatic heart disease in Ethiopia: a systematic review and meta-analysis

Globally, more than 33 million people are living with rheumatic heart disease (RHD). A high prevalence of the disease is observed in people with poor socio-economic status, overcrowding, and low access to medical facilities. Even though different studies have been conducted in different settings, there is no reliable data regarding RHD prevalence. Therefore, the aim of this systematic review and meta-analysis was to estimate the pooled prevalence of RHD in Ethiopia. PubMed/Medline, SCOPUS, HINARI, and Google Scholar databases were used to search for peer-reviewed articles. Articles published in English between the years 1992 and 2022 September were considered. The pooled prevalence of RHD was calculated using a random-effect model at a 95% confidence interval, including the weight of each study. Finally, statistical meta-analysis STATA version 16.0 software was used to calculate the pooled prevalence of RHD.A total of twelve cross-sectional studies were included in the meta-analysis. Individual study prevalence ranges from 0.32 to 32.78%. The pooled prevalence of RHD was 3.19% (95% CI: 1.46-5.56%). The prevalence was higher among the population who visited hospitals at 5.42% (95% CI: 1.09-12.7%) compared to schoolchildren at 0.73% (95% CI: 0.30-1.34%) and community-based studies at 3.83% (95% CI: 3.16-4.55%). Addis Ababa had the lowest prevalence of RHD (0.75% (95% CI: 0.38-1.25%), whereas the highest prevalence was observed in the Amhara region (8.95% (95% CI: 7.21-11.06%). A significant variation in the overall estimated prevalence of RHD was not observed between males and females.Trial registration Protocol registration (PROSPERO): CRD42021251553, Date of registration May 28 2021.

Spatio-temporal evaluation of respiratory disease based on the information provided by patients admitted to a medical college hospital in Bangladesh using geographic information system

In Bangladesh respiratory illnesses are one of the leading risk factors for death and disability. Limited access to healthcare services, indoor and outdoor air pollution, large-scale use of smoking materials, allergens, and lack of awareness are among the known leading factors contributing to respiratory illness in Bangladesh. Key initiatives taken by the government to handle respiratory illnesses include, changing of respiratory health policy, building awareness, enhancing healthcare facility, and promoting prevention measures. Despite all these efforts, the number of individuals suffering from respiratory diseases has increased steadily during the recent years. This study aims at examining the distribution pattern of respiratory diseases over space and time using Geographic Information System, which is expected to contribute to the better understand of the factors contributing to respiratory illness development. To achieve the aims of the study two interviews were conducted among patients with respiratory sickness in the medicine and respiratory medicine units of Rajshahi Medical College Hospital between January and April of 2019 and 2020 following the guidelines provided by the Ethics Committee, Department of Geography and Environmental Studies, University of Rajshahi, Bangladesh (ethical approval reference number: 2018/08). Principal component extraction and spatial statistical analyses were performed to identify the key respiratory illnesses and their geographical distribution pattern respectively. The results indicate, during January-February the number of patients was a lot higher compared to March-April. The patients were hospitalized mainly due to four respiratory diseases (chronic obstructive pulmonary disease, asthma, pneumonia, and pulmonary hypertension). Geographical distribution pattern of respiratory disease cases also varied considerably between the years as well as months of the years. This information seems reasonable to elucidate the spatio-temporal distribution of respiratory disease and thus improve the existing prevention, control, and cure practices of respiratory illness of the study area. Approach used in this study to elicit spatio-temporal distribution of repertory disease can easily be implemented in other areas with similar geographical settings and patients' illness information from hospital.

Health risks associated with the production and usage of charcoal: a systematic review

Charcoal production and utilisation are linked to various health issues and occupational hazards. However, to our knowledge, no systematic review has primarily focused on the health implications of charcoal production and its use while distinguishing charcoal from other solid fuels such as wood and coal.

OBJECTIVES

This systematic review presents a synthesis of the evidence on the health risks associated with producing and using charcoal across the world.

DESIGN

Systematic review using a systematic narrative synthesis approach.

DATA SOURCES

MEDLINE (through Ovid interface), CINAHL, Embase, Web of Science, PsycINFO, Cochrane Library and SCOPUS, from inception to 26 February 2021.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Peer-reviewed journal articles reporting empirical findings on the associations between charcoal usage/production and health parameters.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data and assessed the quality of primary studies.

RESULTS

Our findings showed that charcoal production and usage are linked with specific adverse health outcomes, including respiratory diseases (n=21), cardiorespiratory and neurological diseases (n=1), cancer (n=3), DNA damage (n=3), carbon monoxide (CO) poisoning (n=2), physical injury (n=2), sick house syndrome (n=1), unintentional weight loss and body mass index (BMI) reduction (n=2), increase in blood pressure (n=1) and CO death (n=1). Among the included articles that reported respiratory diseases (n=21), there was one case of asthma and tuberculosis and two cases of chronic obstructive pulmonary disease.

CONCLUSIONS

This review links charcoal production/usage and some associated human health risks. These include respiratory diseases and other non-respiratory illnesses such as sick-building syndrome, cardiovascular diseases, DNA damage, CO poisoning and death, unintentional weight loss and BMI reduction, and physical injuries.

Health risk assessment of indoor air quality, sociodemographic and kitchen characteristics on respiratory health among women responsible for cooking in urban settings of Oromia region, Ethiopia: a community-based cross-sectional study

OBJECTIVES

In Ethiopia, where biomass fuel is used by the majority of the population, women who are primarily responsible for cooking are at a higher risk of having respiratory symptoms. However, there is limited information on the respiratory symptoms of exposed women. This study assessed the magnitude of respiratory disease symptoms and associated factors among women responsible for cooking in Mattu and Bedele towns, south-west Ethiopia.

METHODS

A community-based cross-sectional study was conducted among 420 randomly selected women in urban settings in south-west Ethiopia. Data were collected through face-to-face interviews using a modified version of the American Thoracic Society Respiratory Questionnaire. The data were cleaned, coded and entered into EpiData V.3.1 and exported into SPSS V.22 for analysis. Bivariable and multivariable logistic regression analyses were used to identify factors associated with respiratory symptoms at a value of p<0.05.

RESULTS

It is found that 34.9% of the study participants have respiratory symptoms (95% CI 30.6% to 39.4%). Unimproved floor (adjusted OR (AOR)=2.4 at 95% CI 1.42 to 4.15), presence of thick black soot in the ceiling (AOR=2.1 at 95% CI 1.2 to 3.6), using fuel wood (AOR=2.3 at 95% CI 1.1 to 4.7), using a traditional stove (AOR=3.37 at 95% CI 1.85 to 6.16), long duration of cooking (AOR=2.52 at 95% CI 1.4 to 4.5) and cooking room without a window (AOR=2.4 at 95% CI 1.5 to 3.9) were significantly associated with women's respiratory symptoms.

CONCLUSION

More than two in six women who cook had respiratory symptoms. Floor, fuel and stove type, soot deposits in the ceiling, duration of cooking and cooking in a room without a window were the identified factors. Appropriate ventilation, improved floor and stove design and the switch to high-efficiency, low-emission fuels could help to lessen the effects of wood smoke on women's respiratory health.

Impact of solid fuel usage on respiratory symptoms among reproductive aged women: a cross-sectional study in Sri Lanka

BACKGROUND

Worldwide, around 3 billion people rely on solid fuel for their daily energy needs. Household air pollution secondary to solid fuel burning is a major risk factor for respiratory mobility among vulnerable populations. This study aimed to investigate the respiratory symptoms associated with solid fuel usage, the level of kitchen fuel smoke exposure and its association with respiratory symptoms among reproductive-aged women in Sri Lanka, where most households exclusively use firewood as the primary cooking fuel.

METHODS

A descriptive cross-sectional study was conducted among 403 reproductive-aged women (15 to 49 years) in the Central Province, Sri Lanka. A structured interviewer-administered questionnaire was used to collect data, and an exposure assessment was done using a breath carbon monoxide monitor.

RESULTS

After adjusting for potential confounding factors by the logistic regression models, the odds ratios (OR) of the liquid petroleum gas-only users for at least one respiratory symptom relevant to cough (OR: 0.39; 95% confidence interval [CI]: 0.20-0.78), wheezing (OR: 0.47; 95% [CI]: 0.26-0.87), and dyspnea (OR: 0.44; 95% CI: 0.24-0.84) were significantly lower compared to firewood-only users. The mean of expired air carbon monoxide and estimated carboxyhemoglobin levels of liquid petroleum gas-only users (2.84 ± 2.85 ppm; 1.08 ± 0.46%) were significantly lower than those of firewood-only users (5.27 ± 4.64 ppm; 1.47 ± 0.74%).

CONCLUSIONS

The use of firewood increased the risk of respiratory symptoms among reproductive-aged women in Sri Lanka. Health education focused on positive behavioral changes and effective and efficient clean energy policies are recommended to mitigate the risk associated with solid fuel smoke exposure.

Effects of indoor air pollution on tribal community in rural India and health risk assessment due to domestic biomass burning: a realistic approach using the lung deposition model

Indoor air pollution from the combustion of biomass fuel and associated health risks is a critical issue in developing countries. Concentrations of PM2.5 and PM10 are measured in Birbhum, West Bengal, during 2017-2018. PM2.5-bound elemental concentrations of twelve metals are determined in rural kitchens. The results showed higher toxicological risks in BMF (1.15) than the LPG users (0.14). The risk of non-carcinogenic exposure related with dermal contact and ingestion was observed in the acceptable limits (HQ < 1) for all age groups, and the risk associated with inhalation exposure from Cr, Ni, As, and Mn exceeded the acceptable limit. Results also suggest that carcinogenic risks from ingestion and dermal contact are within the acceptable limit (1 × 10-4-1 × 10-6) except Cr and As which were found to exceed the range. The deposition flux (Dφ) for multiple metals in the head airway region, tracheobronchial region, and alveolar regions was found to be higher in teenagers as compared to other groups, whereas the value was lower in infants. Further, it was notified from the Dφ that the metals could pass through the head airways and harm the tracheobronchial tree and alveolar region, increasing the risk of human health.

The Effect of Chronic Inhouse Biomass Fuel Smoke Exposure on Coronary Slow Flow Phenomenon in Women Living in the Eastern Region of Turkey

Objective:

Biomass fuel (BMF) is still widely used in rural areas for cooking and heating worldwide. BMF smoke inhalation is a prominent cause of respiratory and cardiovascular disease. The slow coronary flow (SCF) phenomenon is known as the delayed opacification of distal coronary arteries on a coronary angiogram. SCF is known to be related to cardiovascular morbidity and mortality. Thus, we aimed to investigate the relationship between exposure to BMF and SCF in women in this study.

Methods:

A total of 457 consecutive women who underwent coronary angiography were retrospectively enrolled in this study. Patients were divided into two groups according to the use of BMF during their lives, from birth to older ages, as biomass exposure group (BEG) and non-exposure group. The presence of SCF was calculated based on thrombolysis in myocardial infarction frame count.

Results:

Two hundred fifty nine patients were in the BEG, whereas 198 patients were in the non-exposure group. The prevalence of SCF was higher in the BEG compared to the non-exposure group (47.9% vs. 13.1%, respectively, p<0.001). The presence of biomass exposure, body mass index, white blood cell count, low-density lipoprotein cholesterol, C-reactive protein, serum creatinine, and hypertension were independent predictors of SCF. The optimal cutoff point of biomass exposure time in years to detect the presence of SCF was 30 years (Area under the curve: 0.71, sensitivity: 0.65, specifity: 0.71).

Conclusions:

Exposure to indoor BMF was associated with a SCF phenomenon in women.

Interrelationship of Indoor Particulate Matter and Respiratory Dust Depositions of Women in the Residence of Dhanbad City, India

Women spend relatively more time in indoor environments in developing countries. Exposure to various indoor air pollutants leads them to higher health risks according to household air quality in which they reside. Particulate matter (PM) exposure with their exposure duration inside the household plays a significant role in women's respiratory problems. This study measured size-segregated particulate matter concentrations in 63 residences at different locations. Respiratory dust depositions (RDDs) for 118 women in their different respiratory regions like head airway (HD), tracheobronchial (TB), and alveolar (AL) regions for the three PM size fractions (PM₁₀, PM_2.5, and PM₁) were investigated. For different positions like light exercise and the sitting condition, RDDs values found for AL region were 0.091 μgmin^-1 (SD: 0.067, 0.012-0.408) and 0.028 μgmin^-1 (SD: 0.021, 0.003-0.126) for PM₁₀, 0.325 μgmin^-1 (SD: 0.254, 0.053-1.521) and 0.183 μgmin^-1 (SD: 0.143, 0.031-0.857) for PM_2.5, 0.257 μgmin^-1 (SD: 0.197, 0.043-1.04) and 0.057 μgmin^-1 (SD: 0.044, 0.009-0.233) respectively for PM₁ to females. RDDs values in the AL region significantly increase as PM₁₀ (11%), PM_2.5 (68%), and PM₁ (21%), confirming that for women, the AL region is the most prominent affected zone by fine particles (PM_2.5).

Healthcare providers infection prevention practices and associated factors in community clinics in Bangladesh: A cross-sectional study

Healthcare associated infections impose serious challenges to safe and high-quality healthcare delivery, and have been closely associated with poor infection prevention practices. Infection prevention practices are poorly studied in Bangladesh, and no previous studies have examined these practices among healthcare providers of community clinics. The study aimed to assess infection prevention practices and associated factors among healthcare providers of community clinics in the rural area of Bangladesh. A cross-sectional study was conducted among 128 community healthcare providers in the Kurigram district of Bangladesh who were identified from 128 community clinics using a stratified random sampling technique. Data were collected between November and December, 2019 via face-to-face survey using a pre-tested semi-structured questionnaire. Only 37.5% community healthcare providers had adequate knowledge on infection prevention measures, and 39.1% had good infection prevention practices. Community healthcare providers with higher education were significantly more likely to have good infection prevention practices, and good infection prevention practices were associated with availability of hand washing facilities, and of soap in community clinic, and adequate knowledge of infection prevention. Implementation of an effective training program regarding infection prevention, along with adequate supply of infection prevention basic resources, and continuous monitoring and supervision are required to improve the currently faltering infection prevention knowledge and practices among community healthcare providers in Bangladesh.

A comparative analysis of biomass and clean fuel exposure on pulmonary function during cooking among rural women in Tamilnadu, India

It is of interest to document data on the comparative analysis of biomass and clean fuel exposure on pulmonary function during cooking among rural women. The study consisted of 100 biomass and 100 LPG fuel using women with no smoking habits and other related illness Parameters such as FVC, FEV1, FEV1/FVC, PEFR, FEF25-75%were obtained using the computerized spirometry to assess the pulmonary function in these subjects. The collected data were analyzed using the Student t-test method and Pearson correlation. The exposure index for biomass fuel users is 69.78±27.25 showing high exposure duration during cooking. The parameters for pulmonary functions significantly declined in FVC (42.34±13.6), FEV1 (45.55±15.98), PEFR (34.11±14.78) and FEF25-75% (45.56±23.00) for biomass fuel user. However, this is not true for FEV1/FVC ratio (107.56±16.9). The increase in PFT suggests the restrictive and obstructive patterns of pulmonary diseases. There was a negative correlation between increased duration of cooking and the value of FEV1/FVC (r = -0.2961), FEF25-75% (r = -0.3519) and PEFR (r = -0.2868). Thus, the deformation of pulmonary function due to extended exposure of biomass fuel for cooking women in rural Tamilnadu is shown using parameter features such as high exposure index, overcrowded area and improper ventilated houses.

Effect of Indoor Air Pollution on Chronic Obstructive Pulmonary Disease (COPD) Deaths in Southern Asia-A Systematic Review and Meta-Analysis

BACKGROUND

About half of the population in developing countries are exposed to indoor pollution such as combustion fuels at present. Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality globally and the primary cause of COPD in women is indoor air pollution exposure, while tobacco smoking is the leading cause in men. The aim of this systematic review and meta-analysis is to evaluate the correlation between the indoor air pollution and deaths related to COPD and COPD prevalence in South Asia.

METHODS

A systematic search on studies with sufficient statistical power has been conducted from 1985 until 30 June 2020, in English electronic databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in MEDLINE and PubMed databases with the terms Chronic Obstructive Pulmonary disease COPD or Chronic Bronchitis or Emphysema or COPD Deaths or Chronic Obstructive Lung Disease or Airflow Obstruction or Chronic Airflow Obstruction or Airflow Obstruction, Chronic or Bronchitis, Chronic and Mortality or Death or Deceased was conducted. Studies were eligible if they were Prospective controlled or non-controlled trials conducted in Southern Asia/ Asia and Retrospective studies conducted in Southern Asia/ Asia.

RESULTS

The results have concluded that long term exposure to indoor pollution had a significant effect on COPD deaths as well as its symptoms. Odd's ratio was in a range of 1.05 (Randomized controlled trials) to 7.87 (Cross sectional studies) for all the studies mentioned. Meta-analysis observed a significantly higher Odds Ratio of 2.13 for COPD mortality and 2.08 for COPD prevalence on exposure to indoor air pollution.

CONCLUSION

Exposure to solid fuel smoke is consistently and significantly correlated with COPD mortality and COPD prevalence in South Asian countries, in spite of heterogeneity observed in the studies included. For performing domestic tasks, initiatives are to be taken to reduce dependency on solid fuel by using cleaner alternatives or comparatively cleaner technology.

Biomass energy, particulate matter (PM2.5), and the prevalence of chronic obstructive pulmonary disease (COPD) among Congolese women living near of a cement plant, in Kongo Central Province

This study investigated whether the individual and combined effects of using biomass energy and living in the neighborhood of a cement plant were associated with the risk of COPD and respiratory symptoms among Congolese women. A total of 235 women from two neighborhood communities of a cement plant participated in this cross-sectional study. Participants were classified into the more exposed group (MEG = 137) and a less exposed group (LEG = 98), as well as into biomass users (wood = 85, charcoal = 49) or electricity users (101 participants). Participants completed a questionnaire including respiratory symptoms, sociodemographic factors, medical history, lifestyle, and household characteristics. In addition to spirometry performance, outdoor PM_2.5 (μg/m³) was measured. Afternoon outdoor PM_2.5 concentration was significantly higher in MEG than LEG (48.8 (2.5) μg/m³ vs 42.5 (1.5) μg/m³). Compared to electricity users, wood users (aOR: 2.6, 95%CI 1.7; 5.9) and charcoal users (aOR: 2.9, 95%CI 1.4; 10.7) were at risk of developing airflow obstruction. Combined effects of biomass use and living in the neighborhood of a cement plant increased the risk of COPD in both wood users (aOR: 4, 95%CI 1.3; 12.2) and charcoal users (aOR: 3.1, 95%CI 1.7; 11.4). Exposure to biomass energy is associated with an increased risk of COPD. In addition, combined exposure to biomass and living near a cement plant had additive effects on COPD.

Association between chronic obstructive pulmonary disease (COPD) and occupational exposures: A hospital based quantitative cross-sectional study among the Bangladeshi population

The association between chronic obstructive pulmonary disease (COPD) and occupational exposures are less studied in Bangladeshi context, despite the fact that occupational exposures are serious public health concerns in Bangladesh. Therefore, this study aimed to evaluate this association considering demographic, health and smoking characteristics of Bangladeshi population. This was a hospital-based quantitative study including 373 participants who were assessed for COPD through spirometry testing. Assessment of occupational exposures was based on both self-reporting by respondents and ALOHA based job exposure matrix (JEM). Here, among the self-reported exposed group (n = 189), 104 participants (55%) were found with COPD compared to 23 participants (12.5%) in unexposed group (n = 184) that differed significantly (p = 0.00). Similarly, among the JEM measured low (n = 103) and high exposed group (n = 236), 23.3% and 41.5% of the participants were found with COPD respectively; compared to unexposed group (14.7%; n = 34), that differed significantly also (p = 0.00). Likewise, participants with longer self-reported occupational exposures (>8 years) showed significantly (p = 0.00) higher proportions of COPD (79.5%) compared to 40.4% in shorter exposure group (1-8 years). Similarly, significant (p = 0.00) higher cases of COPD were observed among the longer cumulative exposure years (>9 years) group than the shorter cumulative exposure years (1-9 years) group in JEM. While combining smoking and occupational exposure, the chance of developing COPD among the current, former and non-smokers of exposed group were 7.4, 7.2 and 12.7 times higher respectively than unexposed group. Furthermore, logistic analysis revealed that after adjustments for confounding risk factors, the chance of developing COPD among the self-reported exposure group was 6.3 times higher (ORs: 6.3, p = 0.00) than unexposed group; and JEM exposure group has odds of 2.8 and 1.1 respectively (p<0.05) for high and low exposures. Further studies are needed to reinforce this association between COPD and occupational exposure in Bangladesh.

Comparative study on respiratory function among rural women using biomass fuel and non-biomass fuel: evidence of a cross-sectional survey in Bangladesh

Respiratory diseases' mortality and morbidity have been a major public health burden primarily attributed to widespread exposure to indoor and outdoor pollutants in the environment. The study conducted among 510 Bangladeshi women residing in the northeastern zone of the Sylhet division from semi-urban and rural settings to compare the biomass fuel users (N = 255) with the non-biomass users (N = 255). It has been observed that all the symptoms had a higher prevalence among the women who were exposed to biomass fuel compared with those exposed to clean gas fuel. Women exposed to biomass group reported frequent cough and phlegm production episodes during a 3-month timeline before the survey period which was found statistically higher (p < 0.001) compared with that of the clean gas fuel group. Moreover, the use of biomass fuel has been associated with a significant decrease in forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), and peak expiratory flow rate (PEFR). Appropriate strategies from stakeholders and government authorities in disseminating health hazards from biomass fuel along with supporting the community by providing alternative energy sources for cooking can largely impact people's lives.

Acute respiratory symptoms and its associated factors among mothers who have under five-years-old children in northwest, Ethiopia

Background

Poor air quality of the household is likely to be the largest public health concern in resource-constrained countries. Exposure to household air pollution, poor working environment, and fuel type used at household level have been associated with respiratory symptoms. This study aimed to assess acute respiratory symptoms and its associated factors among mothers who have under five-years-old children in Gondar city, northwest Ethiopia.

Method

A cross-sectional study was carried out from February 15, 2019 to June 20, 2019. Study participants were selected using simple random sampling, and data were collected via face-to-face interviews. Binary logistic regression analysis was used to test the association of explanatory and outcome variables. Variables with p < 0.05 were considered as significantly associated with the outcome variable.

Results

The prevalence of respiratory symptoms among mothers of under-five years-old children in this study was 46.1%. Education (vocational training compared to cannot read and write) (adjusted odd ratio (AOR) = 0.26 at 95% confidence interval (CI): 0.08–0.82), working in dusty environment (AOR = 2.90 at 95% CI: 1.39–6.08), wood fire use (AOR = 0.37 at 95% CI: 0.16–0.85), living in mud- and wood-walled houses (AOR = 0.53 at CI: 0.32–0.89), recent house painting (AOR = 1.95 at 95% CI: 1.03–3.69), new carpet (AOR = 2.02 at 95% CI: 1.08–3.77), pesticide use (AOR = 1.71 at 95% CI: 1.03–2.84), damp stain (AOR = 2.45 at 95% CI: 1.04–5.75), spending longer time in house for 6 to 11 h (AOR = 2.59 at 95% CI: 1.53–4.37) and 11 to 15 h (AOR = 3.47 at 95% CI: 1.87–6.43), and living less than 100 m from unpaved roads/streets (AOR = 4.35 at 95% CI: 2.64–7.18) were significantly associated with respiratory symptoms among mothers of under-five years-old children.

Conclusion

Respiratory symptoms were common among mothers who have under five-years-old children. Air quality improvement, fuel selection, and residential planning will help to reduce respiratory symptoms.

Risk of COPD due to indoor air pollution from biomass cooking fuel: a systematic review and meta-analysis

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality in developing nations. In this meta-analysis, we aimed to determine the association between indoor air pollution and risk of COPD. Database searches were conducted using indoor air pollution, biomass and COPD related terms to identify relevant articles. The eligible studies were case-control, retrospective cohort, cross-sectional studies and conducted in adults that assessed COPD using any diagnostic criteria. A total of 35 studies with 73,122 participants were included. The pooled analysis showed that exposure to indoor air pollution due to solid biomass fuels increased risk of COPD by 2.65 (95% confidence interval [CI] 2.13-3.31; n = 73,122) and chronic bronchitis by 2.89 (95% CI 2.18-3.82) times more compared to non-biomass fuels. The risk of COPD was higher in Africa region (odds ratio [OR] 3.19), Asia (OR 2.88), South America (OR 2.15), Europe (OR 2.30) and North America (OR 2.14). The results of our meta-analysis indicated that exposure to indoor air pollution due to biomass smoke is strongly associated with COPD.Abbreviations: CS: cross-sectional; CC: case-control; NR: not reported; ATS: American Thoracic Society; BMRC: British Medical Research Council; GOLD: Global Initiative for Obstructive Lung Disease; IAP: indoor air pollution; BMF: biomass fuel; CB: chronic bronchitis; OR: odds ratio; UCI; upper confidence interval; LCI: lower confidence interval; COPD: chronic obstructive pulmonary disease.

Respiratory Symptoms and Lung Function among Ethiopian Women in Relation to Household Fuel Use

Exposure to household air pollution has been linked to chronic obstructive pulmonary disease, respiratory symptoms and reduced lung function. This study aims to assess respiratory symptoms and lung function among Ethiopian women in relation to exposure to HAP. We conducted a cross-sectional study among non-smoking women responsible for household cooking. Data was collected on socio-demographic characteristics, respiratory symptoms and risk factors using a validated questionnaire. Spirometry with reversibility testing was performed according to American Thoracic Society/European Respiratory Society guidelines. We used independent t-test and multivariable logistic regression to compare the means and measure association respectively. A total of 545 women participated in the study out of which 231 (42.3%) performed spirometry with at least three acceptable manoeuvres. Everyone in the rural group and 43% of the urban group were exposed to HAP from solid fuels during cooking. The odds of developing at least one respiratory symptom when compared with those using cleaner fuels are twice as high for women cooking within the living house. We also found significantly lower forced expiratory volume in the first second (FEV1) (L) among solid fuels users compared with cleaner energy users. Given the larger population settlement in the rural areas and the use of solid fuel as the only energy source, there is a higher risk of developing chronic respiratory health problems for those women in Ethiopia.

Way forward for straw burning pollution research: a bibliometric analysis during 1972-2016

Straw burning has become a hot topic in recent years as it poses a great risk not only to the lung health of residents in exposed areas but also to large-scale haze events. In order to have a more comprehensive understanding of straw burning research, based on the bibliometric analysis of Science Citation Index Expanded from Web of Science, the research progress of straw burning pollution from 1972 to 2016 and the future research trends were carried out in this paper. The research focuses on the document type, language, publication year, times cited and its output characteristics, subject category, journal, national and institutional distribution, author, etc. The results show that the study of straw burning pollution has shown a significant increase over the past 45 years. A total of 813 publications were found, and English was the most commonly used language. Articles were the most frequently appeared document types, and the researches were strongly embracing with the top 3 popular subject categories of "environmental sciences and ecology," "agriculture," and "meteorology and atmospheric sciences." We identified that the major journals publishing straw burning pollution research were Atmospheric Environment, followed by Atmospheric Chemistry and Physics. China as a leader in paper quantity played an important role in the research field of straw burning pollution, while the USA and India were located in the second and third positions. The most productive institution was Chinese Academy of Sciences, followed by Peking University and University Arkansas. Based on our analysis and the consideration of current environmental problems, more studies should focus on the following three aspects in the future: driving mechanism of emission characteristics, construction of high-resolution emission inventories, and the influencing mechanism of straw burning pollutants on climate change and human health. Our analysis and prospects can be served as a useful reference for future studies.

Primary Cooking Fuel Choice and Respiratory Health Outcomes among Women in Charge of Household Cooking in Ouagadougou, Burkina Faso: Cross-Sectional Study

Background: Approximately 3 billion people, worldwide, rely primarily on biomass for cooking. This study aimed to investigate the association between respiratory symptoms among women in charge of household cooking and the type of fuel used for cooking. Methods: A community-based cross-sectional survey was conducted. A total of 1705 women that were randomly selected, completed the survey. We also performed a bivariate and a multivariate analysis to verify the possible associations between respiratory symptoms in women in charge of household cooking and the type of cooking fuel used. Results: Dry cough, breathing difficulties, and throat irritation frequencies were statistically high in biomass fuel users when compared to liquefied petroleum gas (LPG) users. It was also the case for some chronic respiratory symptoms, such as sputum production, shortness of breath, wheezing, wheezing with dyspnea, wheezing without a cold, waking up with shortness of breath, waking up with coughing attacks, and waking up with breathing difficulty. After adjustment for the respondents’ and households’ characteristics; dry cough, breathing difficulties, sneezing, nose tingling, throat irritation, chronic sputum production, wheezing, wheezing with dyspnea, wheezing without a cold, waking up with shortness of breath, waking up with coughing attacks, and waking up with breathing difficulty were symptoms that remained associated to biomass fuel compared to LPG. Women who used charcoal reported the highest proportion of all the chronic respiratory symptoms compared to the firewood users. However, this difference was not statistically significant except for the wheezing, waking up with coughing attacks, and waking up with breath difficulty, after adjustment. Conclusion: Exposure to biomass smoke is responsible for respiratory health problems in women. Charcoal, which is often considered as a clean fuel compared to other biomass fuels and often recommended as an alternative to firewood, also presents health risks, including increased respiratory morbidity in women. Effective and efficient energy policies are needed to accelerate the transition to clean and sustainable energies.

Prevalence and Risk Factors of Chronic Obstructive Pulmonary Disease in Bangladesh: A Systematic Review

Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity in low- and middle-income countries (LMICs) including Bangladesh. But no systematic review has been carried out in Bangladesh, which portraits the burden of COPD and its risk factors. Therefore, this systematic review was conducted to find out the prevalence and risk factors of COPD in Bangladesh. We searched PubMed, Google Scholar, Popline, and Banglajol from January 1, 1972 to April 30, 2017. We included studies that reported the prevalence and/or risk factors of COPD among Bangladeshi people. Two researchers independently searched and screened all the articles and extracted data from nine eligible studies. The whole process was verified by another researcher. Quality assessment was performed using a checklist adopted from published articles on quality assessment guidelines of observational studies. Discrepancies were resolved by consensus. Data analysis was done thematically. The pooled COPD prevalence among Bangladeshi adult was 12.5% (95% CI, 10.9-14.1) using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria and 11.9% (95% CI, 11.4-13.6) using the lower limit of the normality (LLN) criteria. The prevalence was higher among males, low socio-economic group, rural residents, and biomass fuel users. Tobacco consumption, exposure to biomass fuel, old age, and history of asthma were identified as major risk factors of COPD. COPD prevalence is high in Bangladesh. It is a timely need for the policy-makers and public health professionals to take pertinent steps for prevention and control of COPD in Bangladesh.

Hypertensive and toxicological health risk among women exposed to biomass smoke: A rural Indian scenario

This study shows that exposure to air pollutants from indoor cooking fuel combustion may be associated with elevated Diastolic Blood Pressure (DBP), Systolic Blood Pressure (SBP), Heart rate and Body mass index (BMI) in rural women of India. 60 premenopausal women (using solely agriculture residues, wood, dung, straw, leaf) and 30 women (solely using clean fuel, LPG) were recruited for this study. An ethically approved questionnaire was used in the study and health parameters were measured by standard instruments. Eight pollutants were measured by calibrated instruments, applied both in the living room as well as kitchens of test-subjects. The Test-subjects were divided into two groups, LPG users, and biomass users, and the toxicological risk was assessed by measurement of PM_2.5 levels in the given indoor environments. The concentrations of all the pollutants were significantly (p < 0.001) higher in biomass users than in LPG using households, except in the case of O₃ (p < 0.40₃) at the time of cooking. Results highlighted that DBP (p < 0.070), SBP (p < 0.143), Heart rate (p < 0.002) and BMI (p < 0.052) were varied in the two fuel user groups. In the case of biomass fuel user toxicological risk was higher (5.21) than LPG users (0.69). Moreover, Symptoms like asthma (25%), cough (76.67%), dizziness (36.67%), eye irritation (88.33%), and shortness of breath (43.33%) were highly prevalent among biomass users than in LPG users. The study highlighted that Biomass using women are more prone to cardiovascular disease and policies should be formulated for their sustainable health.

Chronic obstructive pulmonary disease associated with biomass fuel use in women: a systematic review and meta-analysis

Introduction

Chronic obstructive pulmonary disease (COPD) is a major and growing cause of morbidity and mortality worldwide. The global prevalence of COPD is growing faster in women than in men. Women are often exposed to indoor pollutants produced by biomass fuels burning during household activities.

Methods

We conducted a meta-analysis to establish the association between COPD and exposure to biomass smoke in women.Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched MEDLINE and Scopus databases in 31December 2016, with the terms: "wood", "charcoal", "biomass", "solid fuels", "organic fuel", "biofuel", "female", "women", "COPD", "chronic bronchitis", "emphysema", "chronic obstructive pulmonary disease". Studies were eligible if they were case-control or cross-sectional studies involving exposure to indoor biomass smoke, conducted at any time and in any geographic location. Fixed-effects or random-effects meta-analysis was used to generate pooled OR.

Results

24 studies were included: 5 case-control studies and 19 cross-sectional studies. Biomass-exposed individuals were 1.38 times more likely to be diagnosed with COPD than non-exposed (OR 1.38, 95% CI 1.28 to 1.57).Spirometry-diagnosed COPD studies failed to show a significant association (OR 1.20, 95% CI 0.99 to 1.40). Nevertheless, the summary estimate of OR for chronic bronchitis (CB) was significant (OR 2.11, 95% CI 1.70 to 2.52). The pooled OR for cross-sectional studies and case-control studies were respectively 1.82 (95% CI 1.54 to 2.10) and 1.05 (95% CI 0.81 to 1.30). Significant association was found between COPD and biomass smoke exposure for women living as well in rural as in urban areas.

Conclusions

This study showed that biomass smoke exposure is associated with COPD in rural and urban women.In many developing countries, modern fuels are more and more used alongside traditional ones, mainly in urban area. Data are needed to further explore the benefit of the use of mixed fuels for cooking on respiratory health, particularly on COPD reduction.

Awareness and utilization of community clinic services among women in rural areas in Bangladesh: A cross-sectional study

Background

In recent years, Bangladesh government has accomplished the ambitious project of establishing hospitals 18,000 Community Health Clinics in sub-districts across the country. Operating under the affiliation of the government hospitals, these community health clinics aim to provide free healthcare services and to increase health-awareness among the extreme poor communities in the rural areas. However, a great proportion of the people are still not well aware of the services offered by the community health clinics. Thus, it is imperative to identify the factors of awareness regarding the community clinics. Research-based evidence is necessary to improve the efficacy and service coverage of community clinics among key population.

Methods

Cross-sectional data of size 11,673 women aged 15 to 49 years living in rural settings across seven divisions were extracted from the latest Bangladesh Demographic and Health Survey 2014. The main outcome measures of our study were awareness and utilization of Community Clinic Services (CCs). Descriptive statistics were used to present the baseline socio-demographic and economic characteristics; Chi-square test and logistic regression were performed to identify the factors associated with awareness of community clinics.

Results

About one-third (36.7%) of the women were aware of community clinics. Geographical location, level of education, household wealth status and frequency of reading newspaper were found to be significantly associated with awareness about community clinic services. Services reported to be obtained in the community clinics include family planning, immunization, tetanus, antenatal care, vitamin A, and health care for children and child growth monitoring. In the multivariate logistic regression, the odds of awareness among participants with primary education [p<0.001, AOR = 1.255, 95%CI = 1.107–1.357], secondary qualification [p<0.001, AOR = 1.370, 95%CI = 1.242–1.510] and tertiary [p<0.001, AOR = 1.526, 95%CI = 1.286–1.809] had approximately 23%, 37% and 53% respectively higher odds of awareness when compared to those with no formal education. Compared to the women living in richest households, odds of awareness were approximately 12.5%, 12.8%, 4.5% and 22.4% respectively higher among women reported in poorer, middle, richer and richest household wealth status when compared to poorest wealth status.

Conclusion

Our findings suggested that policies enhancing improved education could benefit health awareness. Poverty elimination and income generation programs among women are also likely to improve awareness about community health clinics in the target population. Special policy attention is required to address the regional variation of awareness about Community clinics.

Household air pollution from various types of rural kitchens and its exposure assessment

Exposure to household air pollutants has become a leading environmental health risk in developing countries. Considering this, real-time temporal variation in fine particulate matter (PM_2.5) and carbon monoxide (CO) concentrations were measured in various types of rural household kitchens. Observed average concentrations of PM_2.5, CO, percent relative humidity (%RH) and temperature (T) in five different kitchen types were 549.6μg/m³, 4.2ppm, 70.2% and 20°C respectively. Highest CO and PM_2.5 concentration were found in household performing cooking in indoor kitchens (CO: 9.3ppm; PM_2.5: 696.5μg/m³) followed by outdoor kitchens (CO: 5.8ppm; PM_2.5: 539.5μg/m³). The concentration of PM_2.5 and CO varied according to the fuel type and highest concentration was observed in kitchens using cowdung cakes followed by agricultural residue>firewood>biogas>Liquefied Petroleum Gas (LPG). Results revealed that the pollutants concentration varied with kitchen type, fuel type and the location of kitchen. An exposure index was developed to calculate the exposure of cook, non-cook and children below 5years. Analysis of exposure index values shows that cooks, who use solid biomass fuel (SBF) in indoor kitchen, are four times more exposed to the harmful pollutants than the cooks using clean fuel. Further, using indoor PM_2.5 concentrations, hazard quotient was calculated based on evaluation of intake concentration and toxicological risk, which also shows that SBF users have higher health risks (hazard quotient>1) than the clean fuel (LPG) users.

Associations of socioeconomic determinants with community clinic awareness and visitation among women: evidence from Bangladesh Demographic and Health Survey-2011

Background

Although Bangladesh has achieved tremendous success in health care over the last four decades, it still lagged behind in the areas of maternal and child malnutrition and primary health care (PHC). To increase access to PHC, the Bangladesh government established approximately 18,000 community clinics (CCs). The purpose of this study was to examine the associations of socioeconomic determinants of women aged 12–49 years with the CCs awareness and visitation.

Methods

We analyzed secondary data provided by Bangladesh Demographic and Health Survey-2011. A two-stage cluster sampling was used to collect the data. A total of 18,222 ever married women aged 12–49 years were identified from selected households and 17,842 were interviewed. The main outcome measures of our study were awareness and visitation of CCs. Bivariate logistic regression was used to calculate odds ratio (OR) and 95 % confidence interval (CI) to examine the associations between the awareness and visiting CCs with socioeconomic determinants.

Results

Low prevalence of awareness about CC (18 %) was observed among studied women and only 17 % of them visited CCs. Significant associations (P < 0.05) with CCs awareness and visitation were observed among aged 20–29 years (adjusted OR = 1.18; 95 % CI = 1.03–1.35 and adjusted OR = 1.49; 95 % CI = 1.05–2.11), primary education (adjusted OR = 1.20; 95 % CI = 1.08–1.34 and adjusted OR = 1.37; 95 % CI = 1.05–1.78), and poorest family (adjusted OR = 1.21; 95 % CI = 1.03–1.42 and adjusted OR = 2.36; 95 % CI = 1.56–3.55, respectively), after controlling potential confounders.

Conclusions

Awareness and visitation of CCs were found to be positively associated with lower economic conditions, young age, and primary education. Awareness and access to CCs might be increased through community activities that involve health care workers. The government should also lower barriers to PHC access through CCs by providing adequate logistics, such as human resources and equipment.

Chronic cough: an Asian perspective. Part 1: Epidemiology

Asia is one of the most diverse and dynamic continents. Due to recent rapid industrialisation and urbanisation, morbidity patterns are likely to be diverse in Asian populations. Chronic cough is a disease condition resulting from host-environmental interactions, and is associated with a high global epidemiological burden. However, the underlying epidemiology remains unclear, particularly in Asia. We performed a literature search to identify peer-reviewed articles on chronic cough in community-based adult Asian populations that have been published between January 2000 and June 2015. In this review, we aim to examine the epidemiological characteristics and determinants of chronic cough in several geographical areas of Asia.

Household environment and behavioral determinants of respiratory tract infection in infants and young children in northern Bangladesh

OBJECTIVES

Respiratory tract infections (RTI) are one of the leading causes of under-five mortality in Bangladesh. Solid biomass fuels are the main source of domestic fuel used for cooking across Bangladesh, leading to smoke and pollution exposure in the home. This article aims to identify risk factors for RTI among children aged under five years in Bangladesh with a particular focus on the household environment, fuel use, and cooking practices.

METHODS

A cross-sectional household-health survey was carried out in 321 households in northern Bangladesh. The survey included care-giver interviews on cooking practices, child health, and household behaviors during cooking. Health status of the youngest child (under five years) from each household was recorded through maternal interviews, medical diagnosis, and assessment of biomarkers (C-reactive protein (CRP), hemoglobin) from finger-prick blood samples. Anthropometric status (weight, height) was recorded.

RESULTS

Children who spent ≥30 minutes/day within 5 feet of the stove during cooking had a significantly increased risk of moderate/severe RTI compared with children spending <30 minutes/day close to the stove (OR = 2.15, 95%CI: 1.20-3.86, P = 0.01), independent of socio-economic status (SES), biomass fuel type (wood, dung, plant-derived, compressed rice husks), child age, anthropometric status, CRP and hemoglobin.

CONCLUSIONS

In environments with a heavy reliance on solid biomass fuels, the amount of time a child spends near the stove during cooking may be an important risk for RTI. These novel findings from Bangladesh warrant further investigation of mother-infant behaviors during cooking in relation to child health, to ascertain whether the association is likely to be causal.

Clinical Characteristics of Patients With Biomass Smoke-Associated COPD and Chronic Bronchitis, 2004-2014

Individuals with chronic obstructive pulmonary disease (COPD) associated with biomass smoke inhalation tend to be women born in rural areas with lifelong exposure to open fires while cooking, but can also include persons with prenatal and childhood exposure. Compared with individuals with COPD due to tobacco smoking, individuals exposed to biomass smoke uncommonly have severe airflow obstruction, low diffusing capacity of the lung for carbon monoxide (DLCO) or emphysema in high-resolution computed tomography (HRCT) but cough, phlegm and airway thickening and air trapping are very common. Autopsies of patients with COPD from biomass smoke exposure show increased pulmonary artery small vessel intimal thickening which may explain pulmonary hypertension, in addition to emphysema and airway disease. Research on similarities and differences in lung damage produced by exposure to biomass fuel smoke while cooking vs. smoking tobacco may provide new insights on COPD. As a public health problem, COPD caused by inhalation of smoke from burning solid fuel is as relevant as COPD caused by smoking tobacco but mainly affects women and children from disadvantaged areas and countries and requires an organized effort for its control. Improved vented biomass stoves are currently the most feasible intervention, but even more efficient stoves are necessary to reduce the biomass smoke exposure and reduce incidence of COPD among this population.