Indoor air pollution from solid fuel and tuberculosis: a systematic review and meta-analysis

Area of Science:

• Environmental Health
• Epidemiology
• Infectious Diseases

Background:

• Indoor air pollution from domestic solid fuel use is a global health concern.
• Tuberculosis (TB) remains a major public health challenge worldwide.
• The association between indoor air pollution and TB requires further investigation.

Purpose of the Study:

• To systematically review and meta-analyze the evidence on the association between indoor air pollution and tuberculosis (TB).
• To update existing knowledge on this environmental and public health issue.

Main Methods:

• Systematic literature search of PubMed and EMBASE for relevant studies up to February 2013.
• Inclusion of randomized controlled trials and observational epidemiological studies on domestic solid fuel use and TB.
• Data extraction and risk of bias assessment by two independent reviewers, followed by random-effects meta-analysis and heterogeneity assessment using I(2) statistics.

Main Results:

• Fifteen studies examined the link between solid fuel use and active TB, and one study focused on latent TB infection.
• Summary odds ratios were 1.17 (95% CI 0.83-1.65) for case-control studies and 1.62 (95% CI 0.89-2.93) for cross-sectional studies.
• Substantial heterogeneity was observed (I(2) 56.2% and 80.5%), and subgroup/meta-regression analyses did not explain it.

Conclusions:

• The current evidence for an association between domestic solid fuel use and TB is of very low quality.
• High-quality research is essential to clarify this association and quantify the public health burden.
• Further studies are needed to establish causality and inform public health interventions.