comparison of respiratory problems among women ...

Respiratory problem among ICS and TCS users

Original Contribution

COMPARISON OF RESPIRATORY PROBLEMS AMONG WOMEN AND CHILDREN OF RURAL HOUSEHOLDS USING IMPROVED COOK STOVE AND TRADITIONAL COOK STOVE Salamat Khandker1, Sk Akhtar Ahmad2, Rashed Ahmed3, Abdur Rob Mollah4, Faruque Parvez5, Manzurul Haque Khan6 ABSTRACT Objectives: The present study investigated the respiratory problems amongst the women and children of the households who used Improved Cook Stoves (ICS) and Traditional Cook Stove (TCD) for cooking their foods and compared the occurrence of respiratory health problems between two groups. Materials and methods: This was a cross sectional comparative study. A total of 554 female households were included as the respondents of this study. The children of the respondents were examined for their health problems. Amongst the selected female households, 285 used Improved Cook Stove (ICS) and 269 used Traditional Cooking Stove for cooking and these two groups were selected from separate villages. During data collection period of the study the females who were available in their houses as per selection criteria of both the groups and agreed to participate in the study were included as the respondents of this study. Results: Majority of the respondents were in the age group of 25 to 29 years. On average the respondents spent 3.36 hours daily for cooking purpose and had experience of cooking about 10 years. Most (85.9%) of them used cow dung, leaf etc. as fuel for cooking. Among the respondents, 8.1 % of ICS group and 7.1% of TCS group mentioned that they never took their children in the kitchen. Significantly (p85.5%) of the kitchen of both the groups were made of Thatch materials (Table 1). Most (81.4%) of the respondents of ICS group mentioned that they used cow dung, paddy husk, leafs etc. and remaining 18.6 % mentioned that they used wood. Amongst the TCS group a higher proportion (85.9%) of the respondents mentioned that they used cow dung, paddy husk, leafs and 14.1% used wood but not statistically different with ICS group (Table 2).

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Respiratory problem among ICS and TCS users

Table 1: Socio-demographic characteristics of the respondents ICS (n=285) Frequency Percent

Characteristics 1. Age (Years) 20-24 25-29 30-34 35-39 ≥ 40 Minimum-Maximum 2. House Type Thatch Tin shaded Semi Pucca 3. Kitchen type Thatch Semi Pucca Tin Others 4. Family Size (No.)

TCS (n=269) Frequency Percent

Total (n=554) Frequency Percent

90 31.6 97 37.0 70 24.6 24 8.2 4 1.4 20 – 44 years

85 31.6 102 37.9 42 15.6 34 12.6 6 2.2 20 – 45 years

175 31.5 199 35.9 112 20.2 58 10.5 10 1.8 20 – 45 years

15 264 6

5.3 92.5 2.2

7 255 7

2.6 94.8 2.6

22 519 13

3.9 93.7 2.4

247 12 16 10

86.7 4.2 5.7 3.4

230 14 17 8

85.6 5.1 6.4 3.0

477 26 33 18

86.2 4.7 5.9 3.2

4.8

5.2

5.1

Table 2: Cooking experiences of the Respondents Cooking Experience

ICS

TCS

Total

1. Daily Cooking (Hours)

3.43

3.29

3.36

2. Duration Cooking (Years)

10.85

9.64

10.26

3. Use of Cooking Fuel

Frequency

Percent

Frequency

Percent

1)

Cow dung, Leaves etc

232

81.4

231

85.9

2)

Wood

53

18.6

38

14.1

Chi Sq; p value χ 2=2.014; p=0.096

Table 3: Awareness regarding the health effects due to exposure to kitchen smoke ICS

TCS

Awareness Frequency

Percent

1. Exposure to Kitchen smoke causes harmful health effects

156

54.7

86

27.9

χ 2=44.453 p=0.000

2. Taking children into kitchen during cooking

258

91.9

250

92.9

χ 2=1.056 p=0.190

Regarding cooking practice it was found that the respondents of ICS group spent on average 3.43 hours daily for cooking purpose while TCS group spent on average 3.29 hours daily and the difference of hours for cooking between two groups was not statistically significant. It was found that majority of the respondents of both the groups had experience of 10

Frequency Percent

Chi Square; p- value

cooking for 9-11 years (Table-2). Amongst the respondents of ICS group, 54.7% believed that the exposure to kitchen smoke might cause health effects particularly respiratory problems to them as well as to their children while amongst the respondents of TCS group 31.9% believed this and the difference was highly statistical significant (χ2=44.453; JOPSOM 2015; 34 (1): 8-13

Respiratory problem among ICS and TCS users

p=0.000). Most of the respondents of both the groups reported that they took their children into the kitchen while they were cooking. However, only 8.1% of the respondents of ICS group and 7.1% of the TCS group mentioned that they did not take their children into the kitchen (Table 3). Table 4 shows that a significantly (χ2=4.639; p=0.019) higher proportion (50.2%) of the respondents of TCS group experienced burning of eyes during cooking while a lower proportion (31.1%) of the respondents of ICS group experienced such burning sensation. Regarding respiratory problems 36.8% of ICS respondents were found to be suffered from respiratory problems. On the other hand 46.5% of the TCS respondents were found to be suffered from respiratory problems and the difference with ICS group was statistically significant

(χ2=5.291; p=0.013). The respiratory problems suffered by the respondents were infections in the lungs and chronic obstructive lung diseases. The children of the respondents also found to be suffered from respiratory problems. It was reported that 58.8% of the children of ICS group and 69.0% of the children of TCS group were found to suffer from respiratory problems and the difference was statistically significant (χ2=7.830; p=0.003). The respiratory problems suffered by the children of ICS and TCS groups were cough (24.6 % and 27.2%), cold (10.2% and 16.5%), ARI (13.9% and 15.9%), pneumonia (7.6% and 13.2%) and asthma (4.5% and 9.5%). The respiratory problems which were significantly high among the children of TCS group were asthma (χ2=5.935; p=0.012) cold (χ2=6.105; p=0.000), and pneumonia (χ2=5.864; p=0.010).

Table 4 Respiratory Problems and other illnesses amongst the women and children Respiratory Problems 1. Children Yes Cough Asthma Cold ARI Pneumonia 2. Women Yes ARI COPD 3)

Burning eyes

ICS

TCS

Frequency Percent n-353 208 58.9 87 24.6 16 4.5 36 10.2

Frequency Percent n-364 251 69.0 99 27.2 25 9.5 60 16.5

49 27

Chi Square; p-value χ 2=7.830; p=0.003 χ 2=0.444; p=0.244 χ 2=5.935;p=0.012 χ 2=6.105; p=0.000

15.9 13.2

χ 2=0.595; p=0.253 χ 2=5.864; p=0.010

125 114 16

46.5 42.4 5.9

χ 2=5.291; p=0.013 χ 2=3.415; p=0.039 χ 2=1.871; p=0.230

185

68.8

χ 2=4.639; p=0.019

13.9 7.6

58 48

105 99 12

36.8 34.7 4.2

171

60.0

n=285

n=269

* Multiple response DISCUSSION Biomass smoke is a major contributor of indoor air pollution and identified as major public health hazard in the developing countries. About half of the world’s households use unprocessed solid fuels and of which more than 80% are in the developing countries such as China, India and Sub-Saharan Africa.2 In Asian countries, the energy ladder as developed by Smith14 shows that the fuel use becomes cleaner, convenient, efficient and costly as people climb up the ladder. In Bangladesh people use more biomass fuel which are in the lower steps of the ladder, it was reported that more than 90% of the rural households use biomass fuel as a primary source of fuel supply4. Households

JOPSOM 2015; 34 (1): 8-13

using solid biomass fuels are reported to be the largest single environmental risk factors and ranks sixth among all risk factors related to ill health.12 Emission of smoke due to combustion of biomass fuel is a major source of indoor pollution which may cause development of many health problems like acute lower respiratory infection (ALRI) in children, chronic obstructive pulmonary disease (COPD), asthma, tuberculosis, low birth weight and infant mortality.8 As women typically cook in rural households and spend 3 to 7 hours, they are likely to receive higher proportion and cumulative exposures of biomass air pollutants.15,16. Indoor air concentration for PM2.5, CO, SO2, and

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Respiratory problem among ICS and TCS users

ammonia was monitored in 140 household kitchens before and after introduction of improved biomass stoves in five counties of China. Significant reductions were found in all pollutants.17,18 Similarly another study also recorded significant reduction in 24 hours exposure to PM2.5 among mothers those used improved stove for cooking.19 A study among 624 infants and young children found that serum IgG content was significantly lower in those whose households used biomass fuel mainly coal for cooking than in those whose households used gas fuels20. These findings supported by another study where it was found that smoke due to biomass fuel combustion weakens the human immune system, making exposed individuals more susceptible for developing illnesses21. Further, it was reported that exposure to indoor coal smoke, a biomass fuel significantly increases lung cancer risk.22. In many studies significant association was found between exposure to smoke of biomass fuel used for cooking and occurrence of asthma, COPD, chronic bronchitis and cardio-vascular diseases.23-26 The women in Bangladesh are reported to be exposed to high concentration particulates matters from kitchen smoke and they spend more than 3 hours per day in the kitchen.3,10 Therefore, according to the findings of studies elsewhere the women in Bangladesh are at high risk of developing COPD and other respiratory problems.10,16,23 In the current study the women of ICS and TCS group were found to spend on an average 3.43 and 3.29 hours daily respectively in the kitchen for cooking, and thus indicate that the women of this study are at risk of developing COPD and other respiratory problems. And it was evident in this study that the women who used TCS for cooking, proportionately suffered more from respiratory problems particularly ARI and COPD compared to that of women using ICS. Further, it was found that the occurrence of ARI were significantly (χ2=3.415; p=0.039) high amongst the women using TCS, which further indicates that as the emission of kitchen smoke is more in non-ICS that might cause occurrence of infections more in the lungs as the emission from biomass combustion weakens immune deficiency.21 Not only were the women of TCS user similar influence also found amongst the children of this study who were from the household using TCS. The children of the TCS households were found to suffer significantly more from respiratory problems particularly cold (χ2=6.105; p=0.000), and pneumonia (χ2=5.864; p=0.010). Moreover, the children of TCS household were found to suffer significantly (χ 2=5.935; p=0.012) more from asthma. In studies it was found that the children who are exposed to smoke of 12

biomass combustions the occurrence of asthma is significantly high.26, 27 The socio-demographic characteristics which were included in this study as determinant factor, none of them was significantly different between the two groups. However, a significant difference was found regarding the belief that exposure to kitchen smoke is responsible for the occurrence of many health effects especially respiratory problems among the exposed persons. And the belief found more among the women of ICS user thus suggests that awareness regarding the health effects of kitchen smoke could be the motivating factor to increase the use of ICS. CONCLUSION Both the women and children of the households who were using improved cooking stove were found to be suffered from respiratory problems less in comparison to that of women and children using traditional cooking stove. The belief about the occurrence of respiratory problems due to exposure to kitchen smoke was found to be a motivating factor for using improved cooking stove and thus more awareness programme should be organized regarding harmful effects of traditional cooking stove. REFERENCES 1.

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