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Indoor air pollution in developing countries and acute lower respiratory infections in children
K R Smith1, J M Samet, I Romieu
1Environmental Health Sciences, University of California, Berkeley 94720-7360, USA. krksmith@uclink4.berkeley.edu
Insights
Household air pollution from biomass fuels significantly increases the risk of acute respiratory infections in young children in developing nations. Urgent research is needed to confirm this link and guide interventions for this widespread public health issue.
Area of Science:
- Environmental Health
- Pediatrics
- Epidemiology
Background:
- Indoor air pollution from biomass fuel use is prevalent in over 40% of global households.
- Biomass fuels include wood, crop residues, and animal dung.
- Focus on acute lower respiratory infection and pneumonia in children under two in less developed countries.
Purpose of the Study:
- To critically review quantitative literature linking indoor air pollution from biomass fuels to acute respiratory infections in young children.
- To assess the risk and public health implications of this exposure.
Main Methods:
- Comprehensive search of Medline and other electronic databases.
- Inclusion of literature from colleagues in less developed countries.
- Critical review of quantitative studies.
Main Results:
- Studies consistently show a strong, significant increase in risk for young children exposed to indoor biomass fuel smoke.
- Most studies, even after adjusting for confounders, found significant risks.
- Exposure is linked to higher rates of acute respiratory infections.
Conclusions:
- Significant risks are associated with indoor air pollution from biomass fuels.
- Acute lower respiratory infection is a leading cause of death in children in developing countries.
- Urgent need for randomized trials to confirm causality, quantify risk, and evaluate interventions.
Background:
A critical review was conducted of the quantitative literature linking indoor air pollution from household use of biomass fuels with acute respiratory infections in young children, which is focused on, but not confined to, acute lower respiratory infection and pneumonia in children under two years in less developed countries. Biomass in the form of wood, crop residues, and animal dung is used in more than two fifths of the world's households as the principal fuel.
Methods:
Medline and other electronic databases were used, but it was also necessary to secure literature from colleagues in less developed countries where not all publications are yet internationally indexed.
Results:
The studies of indoor air pollution from household biomass fuels are reasonably consistent and, as a group, show a strong significant increase in risk for exposed young children compared with those living in households using cleaner fuels or being otherwise less exposed. Not all studies were able to adjust for confounders, but most of those that did so found that strong and significant risks remained.
Conclusions:
It seems that the relative risks are likely to be significant for the exposures considered here. Since acute lower respiratory infection is the chief cause of death in children in less developed countries, and exacts a larger burden of disease than any other disease category for the world population, even small additional risks due to such a ubiquitous exposure as air pollution have important public health implications. In the case of indoor air pollution in households using biomass fuels, the risks also seem to be fairly strong, presumably because of the high daily concentrations of pollutants found in such settings and the large amount of time young children spend with their mothers doing household cooking. Given the large vulnerable populations at risk, there is an urgent need to conduct randomised trials to increase confidence in the cause-effect relationship, to quantify the risk more precisely, to determine the degree of reduction in exposure required to significantly improve health, and to establish the effectiveness of interventions.