Paraffin dangers, health and socioeconomic consequences: Urgent need for policy action.

Illuminating paraffin (kerosene) is the primary cooking fuel for approximately two million South Africans. The highly flammable and toxic fuel is burnt in poorly made stoves that are prone to malfunction and are associated with accidental fires, burns and household air pollution. However, the fuel continues to be used as it is easily decanted, widely available in neighbourhood outlets, perceived as affordable, and often the only available option for low-income urban settlements. It is anticipated that increased and enforced home congestion during COVID-19 lockdowns will exacerbate exposure of homebound families to unsafe energy, especially during the cold winter months. Based on an accumulation of evidence on the health and socioeconomic impacts of paraffin, this article advocates for its expedited phase-out and substitution with safer energy.

Consequences of household air pollution on child survival: evidence from demographic and health surveys in 47 countries.

BACKGROUND: Over one-third of the world's population is exposed to household air pollution (HAP) but the separate effects of cooking with solid fuel and kerosene on childhood mortality are unclear. OBJECTIVES: To evaluate the effects of both solid fuels and kerosene on neonatal (0-28 days) and child (29 days-59 months) mortality. METHODS: We used Demographic and Health Surveys from 47 countries and calculated adjusted relative risks (aRR) using Poisson regression models. RESULTS: The aRR of neonatal and child mortality in households exposed to solid fuels were 1.24 (95% CI: 1.14, 1.34) and 1.21 (95% CI: 1.12, 1.30), respectively, and the aRR for neonatal and child mortality in households exposed to kerosene were 1.34 (95% CI: 1.18, 1.52) and 1.12 (95% CI: 0.99, 1.27), controlling for individual, household, and country-level predictors of mortality. CONCLUSIONS: Kerosene should not be classified as a clean fuel. Neonates are at risk for mortality from exposure to solid fuels and kerosene.

Hydrocarbon emissions and health risks from cookstoves in developing countries.

The nonmethane hydrocarbon emissions from several types of cookstoves commonly used in developing countries were measured in a pilot study conducted in Manila, the Philippines. Four types of fuel, i.e., wood, charcoal, kerosene, and liquefied petroleum gas (LPG), were tested. Because kerosene was burned in three different types of stoves, there were six fuel/stove combinations tested. Fifty-nine nonmethane hydrocarbons were identified frequently in emissions of these cookstoves, with emission ratios to CO2 up to 5.3 x 10(-3). The emissions were quantitated with emission factors on both a mass basis (emissions/kg fuel) and a task basis (emissions/cooking task). On a task basis, combustion of biomass fuels (wood and charcoal) generally produced higher emission factors than combustion of fossil fuels (kerosene and LPG). One type of kerosene stove (wick stove), however, still generated the greatest emissions of some individual and classes of hydrocarbons, indicating that emissions were dependent on not only fuel types but also combustion devices. Some hydrocarbons, e.g., benzene, 1,3-butadiene, styrene, and xylenes, were of concern because of their carcinogenic properties. The lifetime risk from exposures to these compounds emitted from cookstoves was tentatively estimated by using a simple exposure model and published cancer potencies.

The kerosene tragedy of 1994, an unusual epidemic of burns: epidemiological aspects and management of patients.

An unusual and perhaps the first epidemic of burns occurred between 15 February 1994 and mid April 1994 in four districts of the State of Rajasthan in India. The cause of this epidemic was the accidental mixing of petrol in kerosene oil which was inadvertently overlooked. This mixture of kerosene and petrol was used mainly by people of low-income groups for lighting lamps. Most of the accidents occurred while pouring this highly inflammable petrol-kerosene mixture into ignited lamps. A total of 303 cases were reported: 118 of these patients sustained severe burns of whom 37 died. Small numbers of fresh cases kept occurring over a period of 2 months in spite of all efforts by the administration, because poor people kept using the fatal mixture due to ignorance and illiteracy. Most of the patients were managed at district hospitals with the help of plastic surgeons called for the purpose from Jaipur, the capital city of the affected State. A total of 40 out of 303 patients were transferred to SMS Hospital where a medical ward was vacated to manage these patients, as the 10-bed burn unit already had 300 per cent best occupancy. Most of these patients were not willing to be sent to a burn unit situated far away from their homes, but they had to be transferred because the general surgeons working at district hospitals were hesitant to manage them, not so much due to lack of training in the management of burns, but more due to lack of willingness to manage burns. This indicates the need for renewed emphasis not only of the necessity of training general surgeons, nursing and paramedical staff at district level in the management of burns, but also of the need to manage these cases at district level. This idea needs serious consideration and sincere efforts to implement it at the national level. The paper has been split into two parts: epidemiological aspects and management of patients.

Paraffin ingestion--the problem.

Paraffin ingestion is the commonest cause of accidental childhood poisoning in South Africa. Children from the lower socio-economic group are affected most. They drink paraffin in the summer months from bottles or intermediate containers, mistaking it for water or cold-drink. The children are predominantly male with a mean age of 24 months. The clinical picture is one of respiratory distress with a hospital case fatality rate of 0.74%. The use of paraffin as a source of household energy in South Africa is on the increase. Based on a modernisation index it would seem that this trend will continue into the next century. It can therefore be expected that the number of cases of paraffin ingestion will steadily increase if no active steps are taken to address the problem. Prevention should entail a wide spectrum of measures, the basis of which should be a child-resistant container. An effective durable, low-cost child-resistant container which is easy to pour from should be made available by petroleum companies and/or entrepreneurs and distributed through their network. This should be combined with health education on the danger of paraffin. Health care workers and administrators should be made more aware of the problem and become involved in health education and prevention. Further research should be undertaken on the effect a change in the colour of paraffin and the use of child-resistant caps would have on the incidence of paraffin ingestion in South Africa.

Paraffin (kerosene) poisoning in childhood--is prevention affordable in South Africa?

Paraffin (known in some Western countries as kerosene) ingestion is the most common form of acute childhood poisoning in most developing countries. South African black communities reflect a similar pattern, yet the true size and cost of the problem are not known. Without such baseline data the effect of interventions cannot be evaluated. The aim of the study was to determine the incidence and treatment cost of paraffin poisoning in the Cape Peninsula, to identify high-risk areas and to discuss which measures offered the most economical and best preventive potential for this paediatric hazard. A 12-month retrospective study was undertaken in 1990. Relevant patient data were extracted from the files of 6 major Cape Peninsula hospitals. Treatment costs were calculated based on differential hospital costs per inpatient per day, with outpatient costs at one-third of the costs per day. Age-specific rates for affected residential areas were calculated to identify high-risk areas. A total of 436 children (62,5% male), mostly between the ages of 12 and 36 months, were treated at an estimated cost of R111 673. This amount would have been sufficient to provide 95% of households in the 8 identified high-risk areas with child-resistant paraffin containers. In these areas age-specific paraffin poisoning rates ranged from 1,8/1,000 to 7,7/1,000. Strategically planned interventions can be cost-effective when weighed against the treatment cost of cases of paraffin poisoning.