Household heating fuels impact on Acute Respiratory Infection (ARI) symptoms among children in Punjab, Pakistan.

Exposure to household air pollution (HAP) accounted for the loss of 86 million healthy lives in 2019, with almost half of all deaths due to lower respiratory infection among children under 5 years of age. Similarly, the situation in Punjab - Pakistan's largest province - is also not promising. This study was conducted to examine household energy consumption and respiratory symptoms among children under the age of five in rural and urban areas of Punjab. Using data from the Multiple Indicator Cluster Survey (MICS) 2017-18, logistic regression models were applied to the data of a sample of 35,000 children under the age of five living in households with polluting heating fuels. A hypothesis was formulated to investigate the relationship between polluting heating activities and respiratory infections among children under five. Those Children who live in households having traditional space heaters without chimneys are 50% more likely to have symptoms of Acute Respiratory Infection (ARI) compared to those whose households have chimneys with traditional space heaters. When households utilize polluting heating fuel, the likelihood of children experiencing rapid, shortness of breath increases by 49%, and the likelihood of children displaying ARI symptoms characterized by coughing rises by approximately 30%. This study proposed a complete banning of polluting heating activities and replacing it with cleaner ones using financial incentives. It is pertinent to raise awareness campaigns majorly focusing on the guidelines to adopt better heat output with less harmful emissions.

Observations from a peculiar case of volatile substance dependence-A case report.

Volatile substance dependence is a relatively rare form of substance use disorders. It is predominantly noted in the adolescent age group. Higher prevalence is also seen in individuals from the lower socio-economic strata. These agents induce a rapid mood change by altering the levels of central neurotransmitters. Here we present a unique case of volatile substance dependence in a middle aged female with iron deficiency anemia. We managed this with the SSRIs and parenteral iron preparations which led to recovery. This emphasizes the fact that any treatment regimen must address all the factors, co-morbidities and patient characteristics for complete recovery.

[Aspiration pneumonia after ingestion of kerosene - lamp oil is not a remedy]. / Aspirationspneumonie nach Petroleumingestion ­ Lampenöl ist kein Heilmittel.

HISTORY: We present the case of a 78-year old man, who developed aspiration pneumonia and consecutive sepsis after ingestion of a small amount of kerosene. FINDINGS AND DIAGNOSIS: Because unintentional ingestion was suspected first, diagnostic clarification of dementia was requested. Extensive exploration of the patient and third-party anamnesis excluded a psychiatric illness. Instead, a strong belief in alternative medical promises of healing was revealed as the true cause. THERAPY AND COURSE: Thus, psychiatric treatment was not neccessary, while physical condition improved after administration of antimicrobial substances. CONCLUSIONS: Psychiatric consultation may be helpful to diagnostically contextualize behaviour suggesting a mental illness.

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.

The association of household fine particulate matter and kerosene with tuberculosis in women and children in Pune, India.

OBJECTIVES: Household air pollution (HAP) is a risk factor for respiratory disease, however has yet to be definitively associated with tuberculosis (TB). We aimed to assess the association between HAP and TB. METHODS: A matched case-control study was conducted among adult women and children patients with TB and healthy controls matched on geography, age and sex. HAP was assessed using questionnaires for pollution sources and 24-hour household concentrations of particulate matter <2.5 µm in diameter (PM2.5). RESULTS: In total, 192 individuals in 96 matched pairs were included. The median 24-hour time-weighted average PM2.5 was nearly seven times higher than the WHO's recommendation of 25 µg/m3, and did not vary between controls (179 µg/m3; IQR: 113-292) and cases (median 157 µg/m3; 95% CI 93 to 279; p=0.57). Reported use of wood fuel was not associated with TB (OR 2.32; 95% CI 0.65 to 24.20) and kerosene was significantly associated with TB (OR 5.49, 95% CI 1.24 to 24.20) in adjusted analysis. Household PM2.5 was not associated with TB in univariate or adjusted analysis. Controlling for PM2.5 concentration, kerosene was not significantly associated with TB, but effect sizes ranged from OR 4.30 (95% CI 0.78 to 30.86; p=0.09) to OR 5.49 (0.82 to 36.75; p=0.08). CONCLUSIONS: Use of kerosene cooking fuel is positively associated with TB in analysis using reported sources of exposure. Ubiquitously high levels of particulates limited detection of a difference in household PM2.5 between cases and controls.

Lipoid pneumonitis in a patient with an accidental ingestion of kerosene successfully treated with bronchoscopic segmental lavage and systemic steroid: Case report.

RATIONALE: Standard treatment of lipoid pneumonitis remains unclear. This study reports a case of kerosene pneumonitis successfully treated with systemic steroid and segmental bronchoalveolar lavage (BAL). PATIENT CONCERNS: A 30-year-old woman referred to our hospital because of worsening of respiratory symptoms and fever despite antibiotic therapy following accidental ingestion of kerosene. She had no underlying disease. DIAGNOSES: Chest CT scan showed necrotic consolidation, ground glass opacity (GGO), bronchial wall thickening in the right middle/lower lobe (RML/RLL) and right pleural effusion. The lipoid pneumonitis was confirmed by identification of a lipid laden macrophage in bronchoalveolar lavage fluid. INTERVENTIONS: The patient was treated with systemic corticosteroid and segmental BAL. OUTCOMES: The patient's symptoms rapidly improved after treatment and she was discharged one week after admission. A follow-up CT scan a week after discharge revealed marked resolution of consolidation. No recurrence was reported for 8 months. LESSONS: This is the first case of kerosene pneumonitis successfully treated with systemic steroid and bronchoscopic segmental lavage therapy in Korea. Very few cases have been reported worldwide.

Impact of cleaner fuel use and improved stoves on acute respiratory infections: evidence from India.

Background: The use of cleaner fuel and improved stoves has been promoted as a means to lower harmful emissions from solid fuels. However, little is known about how exclusive use of cleaner fuels, mixed fuel use and improved stoves influences children's health. Methods: We compared the impact of using liquefied petroleum gas (LPG) exclusively with mixed fuel use (LPG plus polluting fuels) and with exclusive use of polluting fuels on acute respiratory infections (ARI) among 16 157 children 0-4 years of age from households in the 2012 Indian Human Development Survey. Inverse probability weighting (IPW) procedures for multiple treatments were used for this evaluation. Results: Children from households using LPG had a 5.0% lower probability of reporting ARI relative to exclusive users of polluting fuels, with larger effects (10.7%) in rural households. The probability of ARI in households using improved stoves and mixed fuel use was also lower in rural households, by 2.9% and 2.8%, respectively. The magnitude of effect varied across population subgroups, with the highest effects for children living in households living in kachha (low quality material) houses households identified as poor. Conclusion: Use of LPG and improved stoves lowered the probability of ARI among children younger than 5 years.

Randomized Controlled Ethanol Cookstove Intervention and Blood Pressure in Pregnant Nigerian Women.

RATIONALE: Hypertension during pregnancy is a leading cause of maternal mortality. Exposure to household air pollution elevates blood pressure (BP). OBJECTIVES: To investigate the ability of a clean cookstove intervention to lower BP during pregnancy. METHODS: We conducted a randomized controlled trial in Nigeria. Pregnant women cooking with kerosene or firewood were randomly assigned to an ethanol arm (n = 162) or a control arm (n = 162). BP measurements were taken during six antenatal visits. In the primary analysis, we compared ethanol users with control subjects. In subgroup analyses, we compared baseline kerosene users assigned to the intervention with kerosene control subjects and compared baseline firewood users assigned to ethanol with firewood control subjects. MEASUREMENTS AND MAIN RESULTS: The change in diastolic blood pressure (DBP) over time was significantly different between ethanol users and control subjects (P = 0.040); systolic blood pressure (SBP) did not differ (P = 0.86). In subgroup analyses, there was no significant intervention effect for SBP; a significant difference for DBP (P = 0.031) existed among preintervention kerosene users. At the last visit, mean DBP was 2.8 mm Hg higher in control subjects than in ethanol users (3.6 mm Hg greater in control subjects than in ethanol users among preintervention kerosene users), and 6.4% of control subjects were hypertensive (SBP ≥140 and/or DBP ≥90 mm Hg) versus 1.9% of ethanol users (P = 0.051). Among preintervention kerosene users, 8.8% of control subjects were hypertensive compared with 1.8% of ethanol users (P = 0.029). CONCLUSIONS: To our knowledge, this is the first cookstove randomized controlled trial examining prenatal BP. Ethanol cookstoves have potential to reduce DBP and hypertension during pregnancy. Accordingly, clean cooking fuels may reduce adverse health impacts associated with household air pollution. Clinical trial registered with www.clinicaltrials.gov (NCT02394574).

Use of Cooking Fuels and Cataract in a Population-Based Study: The India Eye Disease Study.

BACKGROUND: Biomass cooking fuels are commonly used in Indian households, especially by the poorest socioeconomic groups. Cataract is highly prevalent in India and the major cause of vision loss. The evidence on biomass fuels and cataract is limited. OBJECTIVES: To examine the association of biomass cooking fuels with cataract and type of cataract. METHODS: We conducted a population-based study in north and south India using randomly sampled clusters to identify people ≥ 60 years old. Participants were interviewed and asked about cooking fuel use, socioeconomic and lifestyle factors and attended hospital for digital lens imaging (graded using the Lens Opacity Classification System III), anthropometry, and blood collection. Years of use of biomass fuels were estimated and transformed to a standardized normal distribution. RESULTS: Of the 7,518 people sampled, 94% were interviewed and 83% of these attended the hospital. Sex modified the association between years of biomass fuel use and cataract; the adjusted odds ratio (OR) for a 1-SD increase in years of biomass fuel use and nuclear cataract was 1.04 (95% CI: 0.88, 1.23) for men and 1.28 (95% CI: 1.10, 1.48) for women, p interaction = 0.07. Kerosene use was low (10%). Among women, kerosene use was associated with nuclear (OR = 1.76, 95% CI: 1.04, 2.97) and posterior subcapsular cataract (OR = 1.71, 95% CI: 1.10, 2.64). There was no association among men. CONCLUSIONS: Our results provide robust evidence for the association of biomass fuels with cataract for women but not for men. Our finding for kerosene and cataract among women is novel and requires confirmation in other studies. Citation: Ravilla TD, Gupta S, Ravindran RD, Vashist P, Krishnan T, Maraini G, Chakravarthy U, Fletcher AE. 2016. Use of cooking fuels and cataract in a population-based study: the India Eye Disease Study. Environ Health Perspect 124:1857-1862; http://dx.doi.org/10.1289/EHP193.

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.

Dermatological problems of asylum seekers arriving on boats: a case report from Australia and a brief review.

Assessing the skin of asylum seekers, immigrants, migrant workers, tourists or even locals who return from abroad, can be a confronting task due to the possibility of such people having non-autochthonous diseases. Primary-care physicians and dermatologists need to have a systematic approach in the assessment of such dermatoses. This article describes an interesting case of possible kerosene-induced and diesel-induced skin injury in an asylum seeker arriving on a boat. Dermatological conditions in asylum seekers and a suggested template for skin assessment are discussed.

Occupational exposure to chlorinated and petroleum solvents and mycosis fungoides.

OBJECTIVE: To evaluate the potential association between occupational exposure to chlorinated and petroleum solvents and mycosis fungoides (MF). METHODS: A questionnaire on lifetime job history was administered to 100 patients diagnosed with MF and 2846 controls. Odds ratios (ORs) were calculated as the measure of the association between exposure to each specific solvent and MF. RESULTS: In the total sample and in men, cases and controls did not differ in relation to exposure to any of the solvents studied. In women, an association with MF was seen for the highest level of estimated exposure to perchloroethylene (OR = 11.38; 95% confidence interval: 1.04 to 124.85) and for exposure less than the median to kerosene/fuel/gasoil (OR = 8.53; 95% confidence interval: 1.11 to 65.62). CONCLUSIONS: These results do not provide conclusive evidence that exposure to solvents may increase risk of MF because they were not found in men.

Household air pollution and stillbirths in India: analysis of the DLHS-II National Survey.

BACKGROUND: Several studies have linked biomass cooking fuel with adverse pregnancy outcomes such as preterm births, low birth weight and post-neonatal infant mortality, but very few have studied the associations with cooking fuel independent of other factors associated with stillbirths. METHOD: We analyzed the data from 188,917 ever-married women aged 15-49 included in India's 2003-2004 District Level Household Survey-II to investigate the association between household use of cooking fuels (liquid petroleum gas/electricity, kerosene, biomass) and risk of stillbirth. Prevalence ratios (PRs) were obtained using Poisson regression with robust standard errors after controlling for several potentially confounding factors (socio-demographic and maternal health characteristics). RESULTS: Risk factors significantly associated with occurrence of stillbirth in the Poisson regression with robust standard errors model were: literacy status of the mother and father, lighting fuel and cooking fuel used, gravida status, history of previous abortion, whether the woman had an antenatal check up, age at last pregnancy >35 years, labor complications, bleeding complications, fetal and other complications, prematurity and home delivery. After controlling the effect of these factors, women who cook with firewood (PR 1.24; 95% CI: 1.08-1.41, p=0.003) or kerosene (PR 1.36; 95% CI: 1.10-1.67, p=0.004) were more likely to have experienced a stillbirth than those who cook with LPG/electricity. Kerosene lamp use was also associated with stillbirths compared to electric lighting (PR 1.15; 95% CI: 1.06-1.25, p=0.001). The population attributable risk of firewood as cooking fuel for stillbirths in India was 11% and 1% for kerosene cooking. CONCLUSION: Biomass and kerosene cooking fuels are associated with stillbirth occurrence in this population sample. Assuming these associations are causal, about 12% of stillbirths in India could be prevented by providing access to cleaner cooking fuel.

Tolerance of cultivated and wild plants of different taxonomy to soil contamination by kerosene.

In laboratory experiments on leached chernozem contaminated by kerosene (1-15 wt.%), germination of 50 plants from 21 families (cultivated and wild, annual and perennial, mono- and dicotyledonous) as affected by kerosene type and concentration and plant features was determined. Tested plants formed three groups: more tolerant, less tolerant, and intolerant, in which relative germination was more than 70%, 30-70% and less than 30%, respectively. As parameters of soil phytotoxicity, effective kerosene concentrations (EC) causing germination depression of 10%, 25% and 50% were determined. EC values depended on the plant species and varied in a wide range of kerosene concentrations: 0.02-7.3% (EC(10)), 0.05-8.1% (EC(25)), and 0.2-12.7% (EC(50)). The reported data on germination in soils contaminated by oil and petrochemicals were generalized. The comparison showed that at very high contamination levels (10 and 15%) kerosene was 1.3-1.6 times more phytotoxic than diesel fuel and 1.3-1.4 times more toxic than crude oil, and at low (1 and 2%) and medium (3 and 5%) levels the toxicity of these contaminants was close differing by a factor of 1.1-1.2. Tolerance of plants to soil contamination had a species-specific nature and, on the average, decreased in the following range of families: Fabaceae (germination decrease of 10-60% as compared to an uncontaminated control)>Brassicaceae (5-70%)>Asteraceae (25-95%)>Poaceae (10-100%). The monocotyledonous species tested were characterized as medium- and low-stable to contamination, whereas representatives of dicotyledonous plants were met in all groups of tolerance. Tested wild plants, contrary to reference data on oil toxicity, were more sensitive to kerosene than cultivated. No correlation was observed between degree of plant tolerance to kerosene and mass of seeds. The evidence indicates factors as structure and properties of testa, structure of germ, type of storage compounds, and type of seed germination (underground or aboveground) are more important.

Experience with corrective surgery for postburn contractures in Mumbai, India.

Postburn contracture is a source of significant morbidity in India, even though its occurrence can be reduced significantly by comprehensive postburn injury care, including surgical intervention. This study investigates whether limited access to initial medical care after burn injury has been associated with increased contracture formation among lower socioeconomic class patients in Mumbai, India. During a surgical mission in Mumbai, India, patients presenting with functionally debilitating burn contractures and minimal income were surveyed for initial care received immediately after burn injury. The survey consisted of questions regarding the history of burn injury and details of any initial treatment. Demographic data were collected by chart review. Thirty-eight patients from the state of Maharashtra participated in the study (mean age 28.1 years). The most common etiology of burn injury was from kerosene stove blasts (74%), and the most common morbidities were contractures of the neck and upper extremity. On average, time elapsed since the original injury was 2.8 years. Nearly all patients sought initial medical care at hospitals (97%) with the majority receiving only dressing changes for their full-thickness or deep-dermal burns (61%). The most common reason for not seeking out delayed burn reconstruction was perceived cost (65%). Ultimately, 60 operations were performed, of which 9 (15%) developed postsurgical complications. These data suggest that a subset of lower socioeconomic class burn patients in Maharashtra received suboptimal initial intervention. Comprehensive initial therapy after burn injury may provide better outcomes and limit the number of patients requiring delayed reconstruction.

Emission factors of gaseous pollutants from recent kerosene space heaters and fuels available in France in 2010.

UNLABELLED: Laboratory measurements of the gaseous emission factors (EF) from two recent kerosene space heaters (wick and injector) with five different fuels have been conducted in an 8-m(3) environmental chamber. The two heaters tested were found to emit mainly CO(2), CO, NO, NO(2), and some volatile organic compounds (VOCs). NO(2) is continuously emitted during use, with an EF of 100-450 µg per g of consumed fuel. CO is normally emitted mainly during the first minutes of use (up to 3 mg/g). Formaldehyde and benzene EFs were quantified at 15 and 16 µg/g, respectively, for the wick heater. Some other VOCs, such as 1,3-butadiene, were detected with lower EFs. We demonstrated the unsuitability of a 'biofuel' containing fatty acid methyl esters for use with the wick heater, and that the accumulation of soot on the same heater, whatever the fuel, leads to a dramatic increase in the CO EF, up to 16 mg/g, which could be responsible for chronic and acute CO intoxications. PRACTICAL IMPLICATIONS: Our results show that in spite of new technologies and emission standards for unvented kerosene space heaters, as well as for the fuels, the use of these heaters in indoor environments still leads to NO(x) levels in excess of current health recommendations. Whereas injection heaters generate more nitrogen oxides than wick heaters, prolonged use of the latter leads to a soot buildup, concomitant with high CO emissions, which could be responsible for acute and chronic intoxications. The use of a biofuel in a wick heater is also of concern. Maintenance of the heaters and adequate ventilation of the room during use of kerosene space heaters are therefore of prime importance to reduce personal exposure.

Association between biofuel exposure and adverse birth outcomes at high altitudes in Peru: a matched case-control study.

Nearly one-third of the Peruvian population burns biofuels for cooking. Similarly, approximately one-third of this population lives at high altitudes. Cooking with biofuels and living at high altitudes have been implicated in adverse perinatal outcomes. This study attempted to determine the risk of low birth weight (LBW) and/or preterm delivery in relation to biofuel use in inhabitants at high altitudes in Peru. A matched-case study was performed in two high-altitude cities. All subjects (n=190) were identified from public-hospital records. Cases were matched by hospital by week of birth and area of residence. Cases were defined as: women with an at-term but LBW newborn; or women with a preterm birth. Adjusted conditional logistic regression analyses were used to determine odds ratio. Fifty-two percent of the cases used biofuel whereas only 30% of the controls used biofuel. The use of biofuel for cooking was found to be strongly associated with increased risks of LBW, but was not significantly linked to preterm births.

Neumonía lipoidea por aspiración accidental de queroseno en un «comedor de fuego» / Lipoid pneumonia by accidental aspiration of kerosene in a «fire eater»

La neumonía lipoidea es una entidad clínica causada por la aspiración o inhalación de sustancias grasas de origen animal. En este artículo se presenta el caso de un paciente de 24 años que realizaba actuaciones esporádicas como «tragafuegos», utilizando el queroseno como elemento fundamental, y que presentó una neumonía lipoidea aguda con resolución completa. Asimismo, se realiza una revisión del tema hasta la fecha actual (AU)

Lipoid pneumonia is a clinical entity caused by aspiration of animal fat substances or their inhalation. This article presents the case of a 24-year old male patient who performed sporadic performances as a «fire eater», using kerosene as a fundamental element, and who had acute lipoid pneumonia with complete resolution. Furthermore, a review is made of the subject up to the present date (AU)

Paraffin-related injury in low-income South African communities: knowledge, practice and perceived risk.

OBJECTIVE: To explore what individuals at risk of injury from using paraffin (also known as kerosene) know about paraffin safety, what they do to protect themselves and their families from paraffin-related injury, and how they perceive their risk for such injury. Also, to explore interrelations between these factors and age, sex, education and income. METHODS: A sample of 238 individuals was randomly recruited from low-income housing districts near Cape Town, South Africa in 2007. Trained research assistants interviewed participants to explore their knowledge about paraffin-related safety and their perceived risk of injury from using paraffin. Researchers inspected participants' homes to evaluate paraffin safety practices. Descriptive and correlational analyses were conducted. FINDINGS: Participants had relatively low levels of knowledge about paraffin-related safety. They had high levels of unsafe practice and their perceived risk of injury was moderate. Knowledge of paraffin safety and safe practices were positively correlated with each other. Greater knowledge showed a negative correlation with the perception of being at risk for injury, but safe practices showed no correlation with perceived risk of injury. Formal education, the number of children in the home and frequency of paraffin use were positively correlated with knowledge but not with safe practices. The only significant correlate to safe practices was greater income, perhaps a reflection of the impact of financial resources on paraffin safety practices. CONCLUSION: To develop successful paraffin safety interventions, it is necessary to understand baseline levels of knowledge, practice and perceived risk of injury among at-risk populations. Our findings could be of value for designing interventions that will increase knowledge, improve safe practices and lead to the accurate perception of the risk of injury from using paraffin.