Abstract
BackgroundBurning biomass fuels indoors for cooking is associated with high concentrations of particulate matter (PM) and carbon monoxide (CO). More efficient biomass-burning stoves and chimneys for ventilation have been proposed as solutions to reduce indoor pollution. We sought to quantify indoor PM and CO exposures in urban and rural households and determine factors associated with higher exposures. A secondary objective was to identify chronic vs. acute changes in cardiopulmonary biomarkers associated with exposure to biomass smoke.MethodsWe conducted a census survey followed by a cross-sectional study of indoor environmental exposures and cardiopulmonary biomarkers in the main household cook in Puno, Peru. We measured 24-hour indoor PM and CO concentrations in 86 households. We also measured PM2.5 and PM10 concentrations gravimetrically for 24 hours in urban households and during cook times in rural households, and generated a calibration equation using PM2.5 measurements.ResultsIn a census of 4903 households, 93% vs. 16% of rural vs. urban households used an open-fire stove; 22% of rural households had a homemade chimney; and <3% of rural households participated in a national program encouraging installation of a chimney. Median 24-hour indoor PM2.5 and CO concentrations were 130 vs. 22 μg/m3 and 5.8 vs. 0.4 ppm (all p<0.001) in rural vs. urban households. Having a chimney did not significantly reduce median concentrations in 24-hour indoor PM2.5 (119 vs. 137 μg/m3; p=0.40) or CO (4.6 vs. 7.2 ppm; p=0.23) among rural households with and without chimneys. Having a chimney did not significantly reduce median cook-time PM2.5 (360 vs. 298 μg/m3, p=0.45) or cook-time CO concentrations (15.2 vs. 9.4 ppm, p=0.23). Having a thatched roof (p=0.007) and hours spent cooking (p=0.02) were associated with higher 24-hour average PM concentrations. Rural participants had higher median exhaled CO (10 vs. 6 ppm; p=0.01) and exhaled carboxyhemoglobin (1.6% vs. 1.0%; p=0.04) than urban participants.ConclusionsIndoor air concentrations associated with biomass smoke were six-fold greater in rural vs. urban households. Having a homemade chimney did not reduce environmental exposures significantly. Measures of exhaled CO provide useful cardiopulmonary biomarkers for chronic exposure to biomass smoke.
Highlights
Burning biomass fuels indoors for cooking is associated with high concentrations of particulate matter (PM) and carbon monoxide (CO)
While previous studies have quantified the concentrations of indoor PM and CO resulting from the combustion of solid fuels [21,22,23,24,25,26], few have attempted to identify biomarkers of such exposures
We evaluated exhaled nitric oxide, exhaled carbon monoxide, carboxyhemoglobin measured from exhaled breath, oxygen saturation (SpO2), carboxyhemoglobin measured from pulse cooximetry (SpHBCO), and heart rate (HR) to evaluate their potential use as clinical biomarkers for biomass smoke exposure
Summary
Burning biomass fuels indoors for cooking is associated with high concentrations of particulate matter (PM) and carbon monoxide (CO). More than half the world population uses solid fuels indoors for cooking and home heating. Incomplete combustion of these materials results in the production of hazardous air pollutants that affect respiratory health [1,2]. The World Health Organization has identified indoor combustion of biomass solid fuels as the fourth leading risk factor for disease burden worldwide [3]. Given the high burden of disease attributable to biomass fuel use, there is considerable interest in the design of interventions, such as chimney stoves, for reducing exposures to indoor biomass smoke. While previous studies have quantified the concentrations of indoor PM and CO resulting from the combustion of solid fuels [21,22,23,24,25,26], few have attempted to identify biomarkers of such exposures
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