Acute Respiratory Symptoms and Risk Factors in Pregnant Women Cooking with Biomass Fuels in Rural Ghana

Abstract

BACKGROUND: Eighty-three percent of the population in Ghana relies on biomass fuels for cooking and heating needs. Household air pollution (HAP) emitted from the incomplete combustion of these fuels has been associated with adverse health effects including respiratory effects in women that can lead to chronic obstructive pulmonary disease (COPD), a major contributor to global HAP-related mortality.OBJECTIVE: This study assessed the prevalence of respiratory symptoms, as well as associations between respiratory symptoms and HAP exposure, as measured using continuous personal carbon monoxide (CO), in nonsmoking pregnant women in rural Ghana.METHODS: We analyzed acute respiratory health symptoms and CO exposures upon enrollment in a subset (n=840) of the population of pregnant women cooking with biomass fuels and enrolled in the GRAPH randomized clinical control trial. Personal CO was measured using Lascar real-time monitors. Associations between CO concentrations as well as other sources of pollution exposures and respiratory health symptoms were estimated using logistic regression models.CONCLUSION: There was a positive association between CO exposure and a composite respiratory symptom score of current cough (lasting > 5days), wheeze or dyspnea (OR: 1.2, 95% CI: 1.02, 1.45). CO was also positively associated with wheeze (OR: 1.3, 95% CI: 1.00, 1.63). Adjusted multivariate models showed significant associations between environmental (second-hand) tobacco smoke (ETS) and the composite outcome (OR: 2.1, 95% CI: 2.0, 3.5), and individual outcomes of cough>5 days (OR: 3.1, 95% CI: 1.31, 7.23), wheeze (OR: 2.7, 95% CI: 1.44, 5.15) and dyspnea (OR: 2.2, 95% CI: 1.19, 3.97), although fewer women were exposed to ETS. Results suggest that exposures to HAP and ETS increase the risk of adverse respiratory symptoms among pregnant women using biomass fuels for cooking in rural Ghana.