Household Air Pollution Risk on Respiratory Health among Women: A Case Study of Indian District after Clean Fuel Programme

Research Article

Austin J Public Health Epidemiol. 2021; 8(3): 1104.

Household Air Pollution Risk on Respiratory Health among Women: A Case Study of Indian District after Clean Fuel Programme

Bhole V*

Department of Public Health and Epidemiology, National Institute of Health and Family Welfare, India

*Corresponding author: Vaishali Bhole, Department of Public Health and Epidemiology, National Institute of Health and Family Welfare, New Delhi, India

Received: May 28, 2021; Accepted: June 23, 2021; Published: June 30, 2021


Objectives: Some of the highest exposures to air pollutants in developing countries occur inside homes where biomass fuels are used for daily cooking. Inhalation of these pollutants may cause deleterious effects on health. Study Design: A total of 450 non-smoking, non-pregnant women aged 15 years and above exposed to domestic smoke from cooking fuels from an early age, working in poorly ventilated kitchen were selected and on investigation presented various health problems.

Method: Symptoms were enquired by means of using standard questionnaire adopted from that of the American Thoracic Society (ATS, 1995). Lung function was assessed by the measurement of Forced Vital Capacity (FVC), (FEV1), i.e. volume of air (in liter) that is forcefully exhaled in one second. Using ratio of FEV1 to FVC (FEVI/FVC), expressed as percentage.

Results: FVC less than 80% of the predicted was considered as abnormal pulmonary function. Symptoms like chest pain, breathlessness, eye irritation, and blackout were found to be significantly higher in biomass users (P <0.05). Moreover, an increasing trend in the prevalence of symptoms/morbid conditions was observed with increase in exposure. Conclusion Thus women exposed to biomass fuels smoke suffer more from health problems and are at greater risk of respiratory illnesses when compared with other fuel users.

Keywords: Biomass fuel; Household air pollution; Health effects; Chronic bronchitis; Lung function; Environmental risk


HAP is recognized as a significant source of potential health risk to exposed populations throughout the world. The major sources of HAP worldwide include combustion of fuels, tobacco smoke, ventilation systems, furnishings and construction materials. These sources vary considerably among developing, and developed nations. Environmental Tobacco Smoke, volatile organic compounds from furnishings and radon from soil are major sources of importance in developed countries [1]. Household Air Pollution (HAP) is caused mainly by the residential burning of solid fuels for cooking and to some extent heating, the major types of which are wood, dung, agricultural residues, coal, and charcoal [2-4]. According to the Global Burden of Disease Report, IAP is the leading cause of Disability Adjusted Life Years (DALYs) in Southeast Asia and the third leading cause of DALYs worldwide [5]. It is considered a silent killer that has resulted in 4.3 million deaths worldwide accounting for 7.7% of the global mortality. The adoption of clean stoves by the 3 billion people using traditional fuels is necessary to achieve health, climate, and gender equality goals [6]. The South-East Asian region contributes to the maximum mortality due to household air pollution followed by the Western Pacific region [7]. A developing country like India faces the dual challenge of exposures from both ambient and household air pollution [5]. The most important issue that concerns indoor air quality in household environments of developing countries like India is the exposure to pollutants released during the combustion of solid fuels. Existing evidence suggests that India, with a population of 1.38 billion people living across states at different levels of economic, social, and health development, has one of the highest air pollution levels in the world [8].

In India, approximately 86.7% of rural households and 26.3% of urban households rely on solid biomass fuels for their cooking needs [9]. These practices can adversely affect the respiratory health of individuals and local forests and other environmental resources, as well as contribute to climate change. When used in simple cooking stoves (mostly traditional Indian Chulah), these fuels emit substantial amount of toxic pollutants that include respirable particles, carbon monoxide, oxides of nitrogen , sulfur, benzene, formaldehyde, 1,3-butadiene, and polyaromatic compounds, such as benzo (a) pyrene [10-16]. In households with limited ventilation as is common in rural household of developing countries, exposures experienced by household members, particularly women and young children who spend a large proportion of their time indoors, have been measured to be many times higher than World Health Organization (WHO) guidelines [17]. Millions of people die every year from exposure to fine particles in polluted air that penetrate deep into the lungs and cardiovascular system, causing diseases including stroke, heart disease, lung cancer, Chronic Obstructive Pulmonary Diseases (COPD) and respiratory infections, including pneumonia. Fine particles less than 2.5 micrometers in diameter (PM2.5) pose the greatest health risks because of their small size, as they can lodge deeply into the lungs. Also, the evidence is now emerging of links with a number of other conditions, including low birth weight, asthma, tuberculosis, cataracts and cancer of the upper airways 18. Household Air Pollution (HAP) arising from the combustion of solid fuels for cooking is a major contributor to four of the top five causes of mortality and morbidity in India, and HAP is a significant contributor to outdoor air pollution [19-21]. Clean cooking fuels are a highly cost-effective health intervention and household’s energybehavior indicates the economic development of a country [21].

In “Pradhan Mantri Ujjwala Yojana” (PMUY), the government provided gas connections to a total of 50 million poor households (from 2016 to 2018) [22]. Piped Natural Gas (PNG) connections have reached more than 11% of households annually with a goal of 20 million by early next decade helping to move LPG to rural areas.

Despite being an industrialized state, over 78% of rural households in Maharashtra state in India use firewood as principle cooking fuel [23]. Yet there is limited data available on health effects involved in the biomass and clean fuels in view of availability of clean fuel the rural areas.


The study was carried out in the rural area of Nagpur district in the state of Maharashtra, India during the span of the year 2017-18. The study was cross sectional and used multistage random sampling technique. The randomization was done at three levels that are district, tehsil (block) and village to identify the study area (Figure 1). District Nagpur has fourteen blocks, out of which Katol was selected randomly for the study, which has 82.38% biomass fuel use according to Census 2011. Katol block has over 165 villages out of which twenty villages were then selected from the block based on their distance from the block headquarter and their proximity from national highway to reduce the confounding factor of vehicular pollution. Seven villages were with-in 10km, 8 were in 10-20 km radius and 5 were more than 20km. All procedures were in accordance with the ethical standards of the Institutional Review Board and with the Helsinki declaration of 1975 that was revised in 2000. Ethical clearance was taken from the Institutional Ethics Committee of Rashtrasant Tukdoji Maharaj Nagpur University India. Informed consent was obtained from all subjects of the study. Respiratory symptoms in detail were enquired by means of a standard questionnaire adopted from the American thoracic society [24], and chronic bronchitis was diagnosed from the presence of cough with expectoration for 3 months in a year for at least two consecutive years on the recommended criteria of ATS. The survey was conducted at two levels, viz., individual and household. The study population was rural women who cook using the different types of fuel. Women aged 15 years and above involved in cooking who were non-smokers, non-pregnant were included in the study. For sample calculation, prevalence of three major diseases like Chronic Obstructive Pulmonary Disease (COPD), lower respiratory infection and low back pain was taken into consideration. Four hundred and fifty (450) households having at least one women cook were selected for collecting primary data on several household parameters like socioeconomic, demographic, and housing characteristics. Information about the prevalence of respiratory symptoms experienced in the past 1 year lasting for 3 months or more, frequency of the signs and symptoms, were collected. Respiratory symptoms broadly included dry cough, cough with phlegm, wheezing and chest discomfort, chest pain and nasal obstruction [25]. In addition, prevalence of headache, eye irritation, nausea, dizziness, shortness of breath etc. were also evaluated. Lung function was measured on completion of interviews. Lung function tests by spirometry were performed with informed consent of the participant. The tests were performed according to the methods suggested by the American Thoracic Society using a portable, electronic spirometer (Schillar Ltd, UK). Calibration checks were undertaken weekly. Before performing the pulmonary function test, each woman was subjected to a detailed history including the history of smoking, location of the kitchen, adequacy of ventilation, type of cooking fuel used, and clinical examination. Exposure was calculated in each woman by the number of hours spent in a day for cooking. Height was measured in standing position and without shoes, and weight was recorded with minimal clothing. Body Mass Index (BMI) was calculated. For spirometry, participants were seated without nose clips and measurements were classified as acceptable if the woman had at least three good blows, and if best and second best values of Forced Expiratory Vital Capacity (FVC) and Forced Expiratory Volume in 1 second (FEV 1), respectively, did not differ by more than 0.20 liters. The data were compared with predictive values based on age, sex and height. The parameters like Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), FEV1% and Forced Expiratory Flow 25-75 (FEF25-75). Peak Expiratory Flow Rate (PEFR) was measured using Wright’s Peak Flow Meter (Clement and Clarke, UK). FVC and FEV1 were expressed in litres, PEFR in litres/min, FEF25-75 in litres/sec, FEV1% was presented as the ratio of FEV1, and FVC expressed in percentage.