ARI And Indoor Air Pollution: Its Burden And Correlation

Abstract

Most of the disease burden in India is due to the respiratory disorders namely acute respiratory infections (ARI), asthma, chronic obstructive pulmonary disease (COPD), tuberculosis (TB) and lung cancer. These diseases are mainly attributed with exposure to indoor pollution, solid-cooking fuels, smoking, poor housing and malnutrition. NATIONAL BURDEN OF DISEASE (NBD) Those disease categories that cause at least 1% of the NBD or at least 1% of all deaths constitute the national burden. Although commonly used, number of deaths is not a very informative indicator of ill health. Better is some measure of the loss of healthy life such as the disability adjusted life year (DALY), which basically indicates the amount of healthy life expectancy lost because of a disease, including both mortality and morbidity. It can be seen that it is the children less than five years, who bear the largest overall illhealth burden of any age group with the major contribution made by ARI. Respiratory diseases such as ARI,TB, COPD and Cancer all contribute to atleast 1% of DALYs and Deaths1. ARI is the largest contributor to the NBD with 12% DALYs and 13% deaths1. INDOOR AIR POLLUTION Four components of indoor pollution are combustion products, chemicals, radon, and biologic agents. Out of the four components, combustion-generated pollutants, principally those from solid-fuel (wood, charcoal, crop residues, dung, and coal) cooking and heating stoves, have been the major culprit. Thus the major source of indoor air pollution is exposure to biomass fuel cooking2It is considered positive if the individual gives the history of regularly cooking at home. STATUS OF HOUSEHOLD FUEL USE IN INDIA The types of cooking fuels used at home included liquefied petroleum gas (LPG), kerosene, or the solid fuels i.e. coal, dried wood, dung and other products of animal or plant origin (biomass fuels). Degree of pollution strongly depends on type of fuel used. . Solid fuels are substantially more polluting per meal than the liquid and gaseous fuels further up on the ‘‘energy ladder.’‘ The amount of important health-damaging pollutants (e.g., PM10, CO, PAH, HCHO, VOC) breathed by a cook during a typical meal is about 2 orders of magnitude lower when burning bottled gas than burning wood or crop residues. Thus, as a first approximation, the use of unprocessed solid fuels in the household is an indicator of the potential for excessive air pollution exposures. In this way, access to clean fuels is parallel to the often-cited statistic on access to clean water as an indicator of disease risk. MAGNITUDE OF PROBLEM Air pollution has become a major concern in India in recent years both because it is now clear that large parts of the Indian urban population are exposed to some of the highest pollutant levels in the world. Annual concentrations reported at urban monitors in India for PM10, particles less than 10 microns in diameter, is of range 90–600 μg/m3, with a population mean of about 200 μg/m3. The 1991 National Census included for the first time a question about the primary household fuel used and reflected that about 95% of the rural population still relied primarily on biomass fuels (dung, crop residues, and wood). A small fraction uses coal, which means about 97% of households relied principally on these unprocessed solid fuels. Nationwide, some 81% of all households relied on these fuels; 3% used coal and 78% used biomass. However recent data as revealed by NFHS-33found that 71 percent of India's households use solid fuels for their cooking and that 91 percent of rural households do so. A study done by SK Jindal etal,4 showed history of exposure ARI And Indoor Air Pollution: Its Burden And Correlation 2 of 5 to combustion of cooking fuels in 36% of subjects but there were large variations at different centers where study was carried out. Majority of subjects at Delhi and Chandigarh used LPG whereas almost similar numbers used LPG or dried solid fuels at Bangalore and Kanpur.