Household air quality and acute respiratory infection in Bangladesh
Weaver, Anne M.
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Acute respiratory infections, including pneumonia and influenza-like illness, are the leading cause of death in children under five years old worldwide and in Bangladesh. Acute respiratory infections disproportionately affect poor children, to whom pharmaceutical-based interventions may be unavailable. Indoor air pollution is a major, potentially modifiable, poverty-related risk factor for acute respiratory infections. In this dissertation, I explored household-level risk factors for influenza-like illness, as well as two potential determinants indoor air pollution exposure, neighborhood biomass cookstove use in a densely-populated area, as well as household ventilation. I first examined household-level risk factors for secondary influenza-like illness among household contacts of individuals with influenza-like illness in rural Bangladesh. Shared latrine use and smoking in the home, an indicator of indoor air pollution exposure, were associated with increased risk of secondary influenza-like illness. The association between shared sanitation and influenza-like illness had not previously been reported, so the mechanism of this association is yet to be determined. These results can inform on future recommendations for sanitation standards. The association between smoking in the home and secondary influenza-like illness further informs the literature on adverse health effects of environmental tobacco smoke and lends evidence to the need for tobacco control initiatives in low-income settings. Cookstoves using biomass fuel (wood, dung, charcoal, etc.) are the major source of indoor air pollution around the world. However, high indoor air pollution concentrations have been observed in homes that use cleaner fuel. I examined the effect of biomass-burning stoves on the air quality (measured as fine particulate matter, PM 2.5 , and carbon monoxide, CO) of neighboring homes that use cleaner fuel in a densely populated urban area of Dhaka, Bangladesh. Air quality of neighboring homes, particularly those sharing a wall with biomass-burning homes, and ambient air pollution are adversely affected by neighborhood biomass cooking. These results highlight the need for clean cooking initiatives to extend to entire communities, not just individual homes. Ventilation has been shown to be associated with acute respiratory infections, either by pathogen clearance or by its potential effects on indoor air quality. We recruited good ventilation (window or door in ≥3 walls) and poor ventilation (no windows, 1 door) homes in Dhaka, Bangladesh. All participants were asked to increase the amount of time they opened their windows and doors and turned their fans on; poor ventilation households were also offered a new window. Although good ventilation homes had better air quality compared to poor ventilation homes, the installation of a single window did not have a statistically significant effect on air quality. Most participants or their landlords refused window installation; the most common reason cited was increased theft risk. Ventilation behavior had a small effect on air quality. A future study will evaluate the association between ventilation and air quality in more detail.