Association between coal and firewood combustion and hospital admissions and mortality in Chile 2015 - An ecological approach.

INTRODUCTION AND OBJECTIVE: Burning coal and firewood generates toxic emissions that are associated with respiratory illness, cardiovascular disease, and even death. The aim of the study is to evaluate the association between county-level prevalence of household coal and firewood use and health outcomes, including total, respiratory, and cardiovascular mortality, as well as total and respiratory hospitalization rates. MATERIAL AND METHODS: The ecological study included data on the use of household coal and firewood in 139 counties obtained from the 2015 Chilean National Socio-economic Characterization Survey. Total, respiratory, and cardiovascular mortality, as well as total and respiratory hospitalization rates, were obtained from the Department of Health Statistics. Poisson models with robust error variance, Pearson linear correlation coefficients, and scatterplots were used to explore associations between household coal and firewood use and morbidity-mortality, stratifying by geographic zone. RESULTS: Total, respiratory, and cardiovascular mortality and total and respiratory hospitalization rates were 5.7 per 1,000, 552 per 100,000, 157 per 100,000, 92.5 per 1000, and 8.8 per 1000 inhabitants, respectively. The median prevalence of coal use for residential cooking, heating, or water heating was 3.64%, while the median prevalence of firewood combustion was 12%. In southern counties, age- and gender-adjusted respiratory mortality increased 2.02 (95% CI: 1.17-3.50), 1.5 (95% CI: 1.11-1.89), and 1.76-fold (95% CI: 1.19-2.60) for each percentage increase in household coal and firewood use for heating, cooking and heating water, respectively. CONCLUSIONS: The prevalence of household coal and firewood used for heating and cooking was positively correlated with respiratory mortality and hospitalization in southern zone counties.

Out of sight, out of mind: participatory sensing for monitoring indoor air quality.

In southern Chile, epidemiological studies have linked high levels of air pollution produced by the use of wood-burning stoves with the incidence of numerous diseases. Using a quasi-experimental design, this study explores the potential of participatory sensing strategies to transform experiences, perceptions, attitudes, and daily routine activities in 15 households equipped with wood-burning stoves in the city of Temuco, Chile. The results suggest that the experience of using a low-cost sensor improves household members' awareness levels of air pollution. However, the information provided by the sensors does not seem to improve the participants' self-efficacy to control air quality and protect themselves from pollution. The high degree of involvement with the participatory sensing experience indicates that the distribution of low-cost sensors could be a key element in the risk communication policies.

Indoor PM2.5 in an urban zone with heavy wood smoke pollution: The case of Temuco, Chile.

Temuco is a mid-size city representative of severe wood smoke pollution in southern Chile; however, little is known about the indoor air quality in this region. A field measurement campaign at 63 households in the Temuco urban area was conducted in winter 2014 and is reported here. In this study, indoor and outdoor (24-hr) PM2.5 and its elemental composition were measured and compared. Infiltration parameters and outdoor/indoor contributions to indoor PM2.5 were also determined. A statistical evaluation of how various air quality interventions and household features influence indoor PM2.5 was also performed. This study determined median indoor and outdoor PM2.5 concentrations of 44.4 and 41.8 µg/m3, respectively. An average infiltration factor (0.62 ±â€¯0.06) was estimated using sulfur as a tracer species. Using a simple mass balance approach, median indoor and outdoor contributions to indoor PM2.5 concentrations were then estimated as 12.5 and 26.5 µg/m3, respectively; therefore, 68% of indoor PM2.5 comes from outdoor infiltration. This high percentage is due to high outdoor pollution and relatively high household air exchange rates (median: 1.06 h-1). This study found that S, Br and Rb were dominated by outdoor contributions, while Si, Ca, Ti, Fe and As originated from indoor sources. Using continuous indoor and outdoor PM2.5 measurements, a median indoor source strength of 75 µg PM2.5/min was estimated for the diurnal period, similar to literature results. For the evening period, the median estimate rose to 135 µg PM2.5/min, reflecting a more intense wood burning associated to cooking and space heating at night. Statistical test results (at the 90% confidence level) support the ongoing woodstove replacement program (reducing emissions) and household weatherization subsidies (reducing heating demand) for improving indoor air quality in southern Chile, and suggest that a cookstove improvement program might be helpful as well.

Emission factors of particulate matter, polycyclic aromatic hydrocarbons, and levoglucosan from wood combustion in south-central Chile.

In south-central Chile, wood stoves have been identified as an important source of air pollution in populated areas. Eucalyptus (Eucalyptus globulus), Chilean oak (Nothofagus oblique), and mimosa (Acacia dealbata) were burned in a single-chamber slow-combustion wood stove at a controlled testing facility located at the University of Concepción, Chile. In each experiment, 2.7-3.1 kg of firewood were combusted while continuously monitoring temperature, exhaust gases, burn rate, and collecting particulate matter samples in Teflon filters under isokinetic conditions for polycyclic aromatic hydrocarbon and levoglucosan analyses. Mean particulate matter emission factors were 2.03, 4.06, and 3.84 g/kg dry wood for eucalyptus, oak, and mimosa, respectively. The emission factors were inversely correlated with combustion efficiency. The mean emission factors of the sums of 12 polycyclic aromatic hydrocarbons in particle phases were 1472.5, 2134.0, and 747.5 µg/kg for eucalyptus, oak, and mimosa, respectively. Fluoranthene, pyrene, benzo[a]anthracene, and chrysene were present in the particle phase in higher proportions compared with other polycyclic aromatic hydrocarbons that were analyzed. Mean levoglucosan emission factors were 854.9, 202.3, and 328.0 mg/kg for eucalyptus, oak, and mimosa, respectively. Since the emissions of particulate matter and other pollutants were inversely correlated with combustion efficiency, implementing more efficient technologies would help to reduce air pollutant emissions from wood combustion. IMPLICATIONS: Residential wood burning has been identified as a significant source of air pollution in populated areas. Local wood species are combusted for home cooking and heating, which releases several toxic air pollutants, including particulate matter, carbon monoxide, and polycyclic aromatic hydrocarbons. Air pollutant emissions depend on the type of wood and the technology and operational conditions of the wood stove. A better understanding of emissions from local wood species and wood stove performance would help to identify better biomass fuels and wood stove technologies in order to reduce air pollution from residential wood burning.

Contaminación intradomiciliaria por material particulado fino (MP2, 5) en hogares de recién nacidos / Indoor air pollution by fine particulate matter in the homes of newborns

Introducción: La contaminación de aire por material particulado (MP) es un importante problema de salud pública. En Chile se ha estudiado la contaminación atmosférica y MP10, y escasamente aire interior y MP2,5. Como los recién nacidos y los lactantes pasan la mayoría del tiempo en el hogar, es necesario evaluar la exposición a la contaminación intradomiciliaria en esta población susceptible. Objetivo: Determinar la concentración de MP2,5 en hogares de recién nacidos e identificar las fuentes de emisión contaminante. Pacientes y método: En 207 hogares se recolectó la concentración de MP2,5 ([MP2,5]) por 24 h y se evaluó la información sociodemográfica y los factores ambientales (calefacción, ventilación, tabaquismo intradomiciliario y aseo del hogar). Resultados: La [MP2,5] mediana fue 107,5 μg/m³. El antecedente «asma familiar¼ se asoció a menor [MP2,5] (p = 0,0495). Hogares sin uso de calefacción mostraron la menor [MP2,5] mediana, 58,6 μg/m³, mientras los que usaron leña, parafina, electricidad entre 112,5 y 114,9 μg/m³ y brasero 162,9 μg/m³. Hogares que usaron leña tuvieron diferencias significativas en [MP2,5] mediana (p = 0,0164) al usar estufa de combustión completa (98,2 μg/m³) versus cocina a leña (112,6 μg/m³) y salamandra (140,6 μg/m³). En el 8,7% de los hogares se reportó consumo de cigarrillos, no asociándose a [MP2,5]. La ventilación se asoció a mayor [MP2,5] mediana (120,6 vs. 99,1 μg/m³; p = 0,0039). Conclusión: Hubo hogares con [MP2,5] elevada, siendo el consumo residencial de leña casi universal y asociado a [MP2,5]. La ventilación natural incrementó el MP2,5 interior, probablemente por infiltración desde el exterior.

Introduction: Air pollution by particulate matter (PM) is a major public health problem. In Chile, the study has focused on outdoor air and PM10, rather than indoor air and PM2.5. Because newborns and infants spend most of their time at home, it is necessary to evaluate the exposure to indoor air pollution in this susceptible population. Objective: To determine concentration of PM2.5 in the homes of newborns and identify the emission sources of the pollutants. Patients and Method: The PM2.5 concentration ([PM2.5]) was collected over a 24 hour period in 207 households. Baseline sociodemographic information and environmental factors (heating, ventilation, smoking and house cleaning), were collected. Results: The median [PM2.5] was 107.5 μg/m³. Family history of asthma was associated with lower [PM2.5] (P = .0495). Homes without heating showed a lower median [PM2.5], 58.6 μg/m³, while those using firewood, kerosene, and electricity ranged between 112.5 and 114.9, and coal users’ homes reached 162.9 μg/m³. Wood using homes had significant differences (P = .0164) in median [PM2.5] whether the stove had complete combustion (98.2 μg/m³) vs. incomplete (112.6 μg/m³), or a salamander stove (140.6 μg/m³). Cigarette smoking was reported in 8.7% of the households, but was not associated with the [PM2.5]. Ventilation was associated with a higher median [PM2.5] (120.6 vs. 99.1 μg/m³, P = .0039). Conclusion: We found homes with high [PM2.5]. Residential wood consumption was almost universal, and it is associated with the [PM2.5]. Natural ventilation increased MP2.5, probably due to infiltration from outside.

[Indoor air pollution by fine particulate matter in the homes of newborns]. / Contaminación intradomiciliaria por material particulado fino (MP2,5) en hogares de recién nacidos.

INTRODUCTION: Air pollution by particulate matter (PM) is a major public health problem. In Chile, the study has focused on outdoor air and PM10, rather than indoor air and PM2.5. Because newborns and infants spend most of their time at home, it is necessary to evaluate the exposure to indoor air pollution in this susceptible population. OBJECTIVE: To determine concentration of PM2.5 in the homes of newborns and identify the emission sources of the pollutants. PATIENTS AND METHOD: The PM2.5 concentration ([PM2.5]) was collected over a 24hour period in 207 households. Baseline sociodemographic information and environmental factors (heating, ventilation, smoking and house cleaning), were collected. RESULTS: The median [PM2.5] was 107.5µg/m3. Family history of asthma was associated with lower [PM2.5] (P=.0495). Homes without heating showed a lower median [PM2.5], 58.6µg/m3, while those using firewood, kerosene, and electricity ranged between 112.5 and 114.9, and coal users' homes reached 162.9µg/m3. Wood using homes had significant differences (P=.0164) in median [PM2.5] whether the stove had complete combustion (98.2µg/m3) vs. incomplete (112.6µg/m3), or a salamander stove (140.6µg/m3). Cigarette smoking was reported in 8.7% of the households, but was not associated with the [PM2.5]. Ventilation was associated with a higher median [PM2.5] (120.6 vs. 99.1µg/m3, P=.0039). CONCLUSION: We found homes with high [PM2.5]. Residential wood consumption was almost universal, and it is associated with the [PM2.5]. Natural ventilation increased MP2.5, probably due to infiltration from outside.

Source identification, apportionment and toxicity of indoor and outdoor PM2.5 airborne particulates in a region characterised by wood burning.

The occurrence of airborne particulate matter has been flagged as "of concern" in several megacities, especially in Asia. Selected Chilean regions have similar problems as wood burning is the major source of heating in homes. This concern has led to mitigation measures restricting the burning of wood at periods when the particulate matter smaller than 2.5 µm (PM2.5) concentrations are predicted to be high. This work investigates the linkage between indoor and outdoor particle concentrations, determines their source through the polyaromatic hydrocarbon (PAH) signature and investigates the efficacy of the current management practice of burning restrictions. The PM2.5 fraction was collected at 12 different properties with coincident indoor and outdoor sampling using a low-volume active sampler for 24 hours. Indoor concentrations of PM2.5 ranged from 6 to 194 µg m(-3) with a mean of 72 µg m(-3) and corresponding outdoor concentrations ranged from 5 to 367 µg m(-3) with a mean of 85 µg m(-3) over the winter periods of 2014 and 2015; the Chilean national permitted maximum in outdoor air is 50 µg m(-3) in 24 hours. Higher concentrations were measured when the outdoor air temperature was lower. The PAHs were analysed on the PM2.5 fraction; the indoor concentrations ranged from 2 to 291 ng m(-3) with a mean of 51 ng m(-3) compared to an outdoor concentration between 3 and 365 ng m(-3) with a mean of 71 ng m(-3). Multivariate statistical analysis of the PAH profiles using principal components analysis (PCA) and polytopic vector analysis (PVA) identified wood burning, static and mobile diesel emissions and kerosene combustion as the major contributors to the particulate matter. When converted to toxicity equivalents (BaP-TEQ), the highest toxicity arising from PAHs in the indoor air was associated with a property that used a "leaky" combined wood stove and heater and also used a wood-fired brazier for local heating. In outdoor air, there was a relationship between the housing density and the BaP-TEQ, such that denser housing had higher BaP-TEQ values. The restrictions in wood burning on selected days may have had a measureable effect on the PM2.5 concentrations in that region but the effects were small and only present for the day of the restriction.

Lower tract respiratory infection in children younger than 5 years of age and adverse pregnancy outcomes related to household air pollution in Bariloche (Argentina) and Temuco (Chile).

The main objective of this study was to evaluate the association between household air pollution with lower tract respiratory infection (LRTI) in children younger than 5 years old and adverse pregnancy outcomes. This retrospective cohort study took place in two cities in Patagonia. Using systemic random sampling, we selected households in which at least one child <5 years had lived and/or a child had been born alive or stillborn. Trained interviewers administered the questionnaire. We included 926 households with 695 pregnancies and 1074 children. Household cooking was conducted indoors in ventilated rooms and the use of wood as the principal fuel for cooking was lower in Temuco (13% vs. 17%). In exposed to biomass fuel use, the adjusted OR for LRTI was 1.87 (95% CI 0.98-3.55; P = 0.056) in Temuco and 1.12 (95% CI 0.61-2.05; P = 0.716) in Bariloche. For perinatal morbidity, the OR was 3.11 (95% CI 0.86-11.32; P = 0.084) and 1.41 (95% CI 0.50-3.97; P = 0.518), respectively. However, none of the effects were statistically significant (P > 0.05). The use of biomass fuel to cook in traditional cookstoves in ventilated dwellings may increase the risk of perinatal morbidity and LRTI.

[Association between indoor contamination and respiratory diseases in children living in Temuco and Padre Las Casas, Chile]. / Fuentes de contaminación intradomiciliaria y enfermedad respiratoria en jardines infantiles y salas cunas de Temuco y Padre Las Casas, Chile.

BACKGROUND: Indoor air pollution, is the main cause of population exposure to polluting agents. AIM: To establish an environmental profile of indoor contamination emission sources in families of children under 5 years that assist to kindergartens in Temuco and Padre Las Casas. To associate respiratory disease episodes in children with indoor contamination. MATERIAL AND METHODS: Cross sectional analysis of 355 family groups subjected to questionnaires about indoor contamination and number of respiratory disease episodes. RESULTS: Forty six percent of mothers or caregivers smoked, 37% smoked at home and 93% smoked one to two cigarettes per day. There was a significant association between respiratory diseases in children and drying clothes in the kitchen, using firewood for heating and the presence of humidity in the dwelling. Mothers identified as indoor contaminants the use of braziers in 76% of cases and firewood stoves in 24%. Ninety seven percent considered that these appliances were detrimental for respiratory health. CONCLUSIONS: The lack of awareness about indoor contamination among subjects of low socioeconomic status should prompt educational campaigns to modify behaviors in their dwellings.

Fuentes de contaminación intradomiciliaria y enfermedad respiratoria en jardines infantiles y salas cunas de Temuco y Padre Las Casas, Chile / Association between indoor contamination and respiratory diseases in children living in Temuco and Padre Las Casas, Chile

Background: Indoor air pollution, is the main cause of population exposure to polluting agents. Aim: To establish an environmental profile of indoor contamination emission sources in families of children under 5years that assist to kindergartens in Temuco and Padre Las Casas. To associate respiratory disease episodes in children with indoor contamination. Material and methods: Cross sectional analysis of 355 family groups subjected to questionnaires about indoor contamination and number of respiratory disease episodes. Results: Forty six percent of mothers or caregivers smoked, 37 percent smoked at home and 93 percent smoked one to two cigarettes per day. There was a significant association between respiratory diseases in children and drying clothes in the kitchen, using firewood for heating and the presence of humidity in the dwelling. Mothers identified as indoor contaminants the use of braziers in 76 percent of cases and firewood stoves in 24 percent. Ninety seven percent considered that these appliances were detrimental for respiratory health. Conclusions: The lack of awareness about indoor contamination among subjects of low socioeconomic status, should prompt educational campaigns to modify behaviors in their dwellings.

Measurements of children's exposures to particles and nitrogen dioxide in Santiago, Chile.

An exposure study of children (aged 10-12 years) living in Santiago, Chile, was conducted. Personal, indoor and outdoor fine and inhalable particulate matter (< 2.5 .m in diameter, PM2.5 and < 10 microm in diameter, PM10, respectively), and nitrogen dioxide (NO2) were measured during pilot (N = 8) and main (N = 20) studies, which were conducted during the winters of 1998 and 1999, respectively. For the main study, personal, indoor and outdoor 24-h samples were collected for five consecutive days. Similar mean personal, indoor and outdoor PM2.5 concentrations (69.5, 68.5 and 68.1 microg/m3, respectively) were found. However, for coarse particles (calculated as the difference between measured PM10 and PM2.5, PM2.5-10), indoor and outdoor levels (35.4 and 47.4 microg/m3) were lower than their corresponding personal exposures (76.3 microg/m3). Indoor and outdoor NO2 concentrations were comparable (35.8 and 36.9 ppb) and higher than personal exposures (25.9 ppb). Very low ambient indoor and personal O3 levels were found, which were mostly below the method's limit of detection (LOD). Outdoor particles contributed significantly to indoor concentrations, with effective penetration efficiencies of 0.61 and 0.30 for PM2.5 and PM2.5-10, respectively. Personal exposures were strongly associated with indoor and outdoor concentrations for PM2.5, but weakly associated for PM2.5-10. For NO2, weak associations were obtained for indoor-outdoor and personal-outdoor relationships. This is probably a result of the presence of gas cooking stoves in all the homes. Median I/O, P/I and P/O ratios for PM2.5 were close to unity, and for NO2 they ranged between 0.64 and 0.95. These ratios were probably due to high ambient PM2.5 and NO2 levels in Santiago, which diminished the relative contribution of indoor sources and subjects' activities to indoor and personal PM2.5 and NO2 levels.

[Indoor air pollution in southeast Santiago, Chile]. / Contaminación aérea intradomiciliaria en el área sur-oriente de Santiago.

BACKGROUND: Indoor air pollution could play an important role in the susceptibility to respiratory diseases of vulnerable individuals, such as elders and infants. AIM: To evaluate indoor air pollution in a low income population of South East Santiago. SUBJECTS AND METHODS: A domiciliary survey of contaminant sources was carried out in the bouses of a cohort of 522 children less than one year old. Using a case-control design, 121 children consulting for respiratory diseases were considered as cases and 131 healthy infants of the same age and sex were considered as controls. In the houses of both groups, active monitors for particulate matter (PM10) and passive monitors for NO2 were installed. RESULTS: Forty two percent of fathers and 30% of mothers were smokers, and in two thirds of the families there was at least one smoker. Eighty five percent used portable heaters in winter. Of these, 77% used kerosene as fuel. Only 27% had water heating appliances. The rest heated water on the kitchen store or on bonfires. Most kitchen stoves used liquid gas as fuel. Twenty four hour PM10 was 109 +/- 3.2 micrograms/m3. Mean indoor and outdoor NO2 in 24 h was 108 +/- 76.3 and 84 +/- 53.6 micrograms/m3 respectively. Indoor NO2 levels were related to the use of heating devices and smoking. No differences in PM10 and NO2 levels were observed between cases and controls. CONCLUSIONS: There is a clear relationship between indoor pollution and contaminating sources. Indoor NO2 levels are higher than outdoors.