Exposure levels to PM2.5 and black carbon for people with disabilities in rural homes of Colombia.

Indoor exposure to air pollutants emitted by solid fuels used for cooking or heating homes remains as a problem to solve. The most affected people are newborns, mothers, children, and people with disabilities, due to the time they spend at home. This study is the first in a rural area of South America, which measures indoor air pollutants (PM2.5 and black carbon) in different environments, inhabited by people with disabilities. The research was supported through a sociodemographic characterization, a methodology useful for future studies, continuous monitoring for 72 h of pollutants, and emission sources, cooking habits, and pre-existing diseases were identified. The primary sources of emissions are improved wood-burning stoves and their chimney. In households where firewood is used, the average concentrations of PM2.5 were the highest (between 10.9 and 3302.5 µg/m3), as were the average concentrations of BC (average 72 h between 2.6 and 51.2 µg/m3) compared with the houses that use gas (average 72 h between 2.6 and 6 µg/m3). In 57% of the households visited, the World Health Organization (WHO) guidelines for PM2.5 (25 µg/m3 for 24 h) were exceeded. The results reveal that rural concentrations of BC can be up to 2.5 times higher than those of an urban area with high vehicular traffic and high population density and could be used to establish a baseline that allows the implementation of control mechanisms to reduce pollution of indoor air.

El uso de estufas eficientes y su impacto en la promoción de la salud en el contexto colombiano / The use of efficient stoves and its impact on the promotion of health in context Colombian

La contaminación del aire intramural, asociada a uso de combustibles de biomasa y carbón para la preparación de alimentos se asocia en Colombia con 1000 muertes cada año (Ministerio de Ambiente y Desarrollo Sostenible (MADS), 2015) y se estima que el 42% de los casos de Enfermedad Pulmonar Obstructiva Crónica (EPOC) se relacionan con factores ambientales. Según la OPS/OMS, el uso de combustibles sólidos para cocinar es un problema de salud pública y el principal riesgo ambiental en las Américas, afectando a casi 90 millones de personas. La Organización Mundial de la Salud (OMS) estima 81424 muertes en las Américas en el 2012 como consecuencia del uso de combustibles sólidos (UCS) para cocinar y calentarse y más de 2.5 millones de años de vida ajustados por discapacidad (DALYs por su sigla en inglés) (WHO, 2015). Las Directrices de la OMS sobre la Calidad del Aire de Interiores: Quema de Combustibles en los Hogares alertan del peligro del UCS y establecen metas para reducir las emisiones de contaminantes nocivos para la salud procedente de fogones, estufas y lámparas de mecha de uso doméstico (Organización Mundial de la Salud (OMS) , 2006). Este documento contiene un aporte de información para la discusión sobre el impacto potencial del uso de estufas eficientes en la salud de las poblaciones expuestas a contaminantes del aire, generados por el uso de combustibles sólidos para cocinar. Así mismo presenta las recomendaciones sobre las opciones que ofrecen los mayores beneficios para proteger la salud de quienes no tienen acceso a fuentes de energía más limpia.

Prevalence, risk factors and underdiagnosis of asthma and wheezing in adults 40 years and older: A population-based study.

OBJECTIVE: There are differences in the prevalence and risk factors of asthma around the world. The epidemiological situation of adults 40 years and older is not well established. Our aim was to determine the prevalence, underdiagnosis and risk factors of asthma and wheezing in adults in Colombia. METHODS: A cross-sectional, population-based study including 5539 subjects from 40 to 93 years selected by a probabilistic sampling technique in five cities was conducted. MEASUREMENTS: respiratory symptoms and risk factors questionnaire and spirometry. DEFINITIONS: (a) Wheezing: Affirmative answer to the question "have you ever had two or more attacks of "wheezes" causing you to feel short of breath?" (b) Asthma: Wheezing definition and FEV1/FVC post-bronchodilator ≥ 70%. (c) Underdiagnosis: Asthma definition without a physician-diagnosis. Logistic regression was used for exploring risk factors. RESULTS: Prevalence of asthma was 9.0% (95% CI: 8.3-9.8) and wheezing 11.9% (95% CI: 11.0-12.8). Asthma underdiagnosis was 69.9% and increased to 79.0% in subjects 64 years or older. The risk factors related to asthma and/or wheezing were: living in Bogota or Medellin, female gender, first degree relative with asthma, respiratory disease before 16 years of age, obesity, no education, indoor wood smoke exposure and occupational exposure to dust particles, gases or fumes. CONCLUSION: We described the epidemiologic situation of asthma in adults 40 years and older in Colombia. In addition to some recognized risk factors, our data supports the association of indoor wood smoke and occupational exposures with asthma and wheezing. Underdiagnosis of asthma in adults was high, particularly in older subjects.

Contaminación del aire de interiores en hogares en situación de pobreza extrema en Colombia / Indoor air pollution in extremely poor Colombian households

Objetivo Caracterizar la exposición a la contaminación del aire interior por uso de combustibles sólidos en hogares en situación de pobreza extrema en Colombia. Métodos A partir de la información gubernamental oficial de hogares en situación de pobreza extrema (encuesta Red Unidos de septiembre 2012, n=1,3 millones de hogares y >5 millones de individuos) se estructuraron dos modelos de regresión logística: (i) Factores asociados al uso de combustibles sólidos para cocinar a nivel hogar, (ii) Asociación entre el uso de combustibles sólidos en el hogar y prevalencia de limitaciones de la salud a nivel individuo. Resultados Un total de 530 mil hogares en situación de pobreza extrema donde habitan 2,1 millones de colombianos, enfrentan el factor de riesgo (uso de combustibles fósiles en el hogar). La presencia del factor de riesgo está asociada a la zona rural (odds ratio-OR=19,4; intervalo de confianza al 95 %-IC95 %: 19,2-19,6), la etnia indígena (OR=2,9; IC95 %:2,9-3,0) y, de manera inversa, a la situación de desplazamiento (OR=0,6;IC95 %:0,6-0,6). La prevalencia de limitación cardiovascular y/o respiratoria, así como de limitación en visión se asociaron con la exposición. Discusión Las iniciativas que busquen mejorar la salud ambiental y calidad de vida de la población rural de mayor vulnerabilidad socio-económica del país cuentan con información de caracterización e impacto para priorizar programas tendientes a disminuir la exposición al uso de combustibles sólidos.

Objective Characterising exposure to indoor air pollution arising from solid-fuel use in extremely poor Colombian households. Methods Data from the September 2012 survey by Red Unidos (literally United Network, the Colombian government's official instrument for identifying extremely poor households: n=1.3 million households and >5 million people) was used for two logistic regression models: factors associated with solid fuel used in cooking within households and an association between exposure to solid fuel use in households and the prevalence of limitations regarding individual health. Results According to the Red Unidos data-based models, 2.1 million people living in 530,000 extremely poor households were exposed to environmental health risk (i.e. household air pollution caused by solid fuel use). Such risk was found to be related to living in rural areas (odds ratio (OR)=19.4 95 % confidence interval (95 %CI): 19.2-19.6 %), having an Indian background (OR=2.9: 2.9-3.0 95 %CI) and, inversely (i.e. when living in towns), internal displacement (OR=0.6: 0.6-0.695 %CI). The prevalence of permanent cardiovascular and respiratory limitations and limited vision were associated with exposure to indoor air pollution arising from solid fuel use. Discussion Initiatives for improving environmental health and the quality of life for extremely poor rural households in Colombia must make full use of the available characterisation data and its impact for prioritising programmes aimed at reducing exposure to solid fuel use.

[Indoor air pollution in extremely poor Colombian households]. / Contaminación del aire de interiores en hogares en situación de pobreza extrema en Colombia.

OBJECTIVE: Characterising exposure to indoor air pollution arising from solid-fuel use in extremely poor Colombian households. METHODS: Data from the September 2012 survey by Red Unidos (literally United Network, the Colombian government's official instrument for identifying extremely poor households: n=1.3 million households and >5 million people) was used for two logistic regression models: factors associated with solid fuel used in cooking within households and an association between exposure to solid fuel use in households and the prevalence of limitations regarding individual health. RESULTS: According to the Red Unidos data-based models, 2.1 million people living in 530,000 extremely poor households were exposed to environmental health risk (i.e. household air pollution caused by solid fuel use). Such risk was found to be related to living in rural areas (odds ratio (OR)=19.4 95 % confidence interval (95 %CI): 19.2-19.6 %), having an Indian background (OR=2.9: 2.9-3.0 95 %CI) and, inversely (i.e. when living in towns), internal displacement (OR=0.6: 0.6-0.695 %CI). The prevalence of permanent cardiovascular and respiratory limitations and limited vision were associated with exposure to indoor air pollution arising from solid fuel use. DISCUSSION: Initiatives for improving environmental health and the quality of life for extremely poor rural households in Colombia must make full use of the available characterisation data and its impact for prioritising programmes aimed at reducing exposure to solid fuel use.

Woodsmoke exposure and risk for obstructive airways disease among women.

OBJECTIVE: To investigate if exposure to firewood smoke and other indoor pollutants is a potential risk factor for obstructive airways disease (OAD) among women in Bogota in whom cigarette smoking and other known risk factors may not be the most frequent. DESIGN AND SETTING: We conducted a hospital-based case-control study to identify risk factors for OAD among women in Bogota. An interview was conducted using a modified questionnaire recommended by the American Thoracic Society for epidemiologic studies. PATIENTS: We compared 104 OAD cases with 104 controls matched by hospital and frequency matched by age. ANALYSIS: The odds ratio (OR) was used as the basic statistic to evaluate risk. Multivariate analysis (MA) was conducted by the Mantel-Haenszel procedure and by logistic regression. MAIN RESULTS: Univariate analysis showed that tobacco use (OR = 2.22; p < 0.01), wood use for cooking (OR = 3.43; p < 0.001), passive smoking (OR = 2.05; p = 0.01), and gasoline use for cooking (OR = 0.52; p = 0.02) were associated with OAD. Trends for years of tobacco use and years of wood cooking were present (p < 0.05). After MA, variables remained significant except gasoline use. CONCLUSIONS: This study showed that among elderly women of low socioeconomic status in Bogota, woodsmoke exposure is associated with the development of OAD and may help explain around 50% of all OAD cases. The role of passive smoking remains to be clarified. This work may set the basis for interventional studies in similar settings.