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Health Impact of Biomass Fuel Use in Rural India

Health Impact of Biomass Fuel Use in Rural India. Twisha Lahiri Manas Ranjan Ray. Chittaranjan National Cancer Institute, Kolkata, India. Traditional biomass fuel used by 578 million (78%) people & constitutes 80% of domestic energy consumption Annual consumption –

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Health Impact of Biomass Fuel Use in Rural India

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  1. Health Impact of Biomass Fuel Use in Rural India Twisha Lahiri Manas Ranjan Ray Chittaranjan National Cancer Institute, Kolkata, India

  2. Traditional biomass fuel used by 578 million (78%) people & constitutes80%of domestic energy consumption Annual consumption – Wood & crop residues- 300 million tonnes Dung– 100 million tonnes Biomass Fuel Use in India Urban-285 million (27.8%) Rural-742 million (72.2%) Energy efficiency & capital cost: wood > crop residue > dung Scarcity of wood cause switch to inferior fuel

  3. Biofuel Emission Concentration: 10-100 times NAAQS: dung > crop residues > wood Composition: Complex mixture Gases: CO, NOx, SO2 etc. HC & VOC : Benzene, Xylene, 1,3-Butadiene etc. PAH: Benzo-a-pyrene, Benz-anthracene Metals: Pb, Fe, Cd, Zn, Ni Particulate matter: Of different size and composition Exposure: high - short duration ( 2-4hrs / day) Target group : women & children The health effects are the impact of this complex mixture rather than a particular pollutant.

  4. The Biofuel Menance • 600,000 (approx.) premature deaths / yr. (5.3%) among women & children in India (Smith et al, 2002) • Biofuel use associated with • acute respiratory infection • COPD • cancer • tuberculosis • adverse pregnancy outcomes • blindness / cataract & heart disease • Aim of the study : To assess thePulmonary & • systemic effects of exposure to biomass fuel • emission by pollution sensitive biomarkers to • develop Medical & Air Pollution Intervention • Strategies

  5. Study Approach • Population -850 women of rural West Bengal & Uttaranchal, age & socioeconomic status matched 300 rural women of WB using LPG (controls) • Questionnaires - personal history & respiratory symptoms • Clinical examination & lung function test by Spirometry • Sampling & laboratory investigation • Sputum-alveolar macrophage responses (numerical, structural & functional)sputum cytology and infiltrating leukocytes • Buccal mucosa-nuclear abnormalities and micronucleus • Blood-Hematological alteration • Blood biochemistry • Immune response- T cells, B cells, NK cells & • Platelet activation status by FACS • Statistical analysis – chi-square test, logistic regression etc. • SYSTAT 9.0 (SPSS, Chicago)

  6. Respiratory Symptoms URS Control Biomass user LRS Other Symptoms

  7. Lung Function Impairment • 10,000 – 15,000 liters of air enter an adult lung / day. Target – 300 million alveolus • Increase in conc. of pollutants increases toxic insult to the lung • From alveolus pollutants travel via lymph or blood to diff. organs % of individuals Control Biomass user Normal Restrictive Obstructive Combined

  8. Alveolar Macrophage (AM) Response AM – A Biomarker of Pollution Effect - Interact directly with toxic particles and gases - phagocytosis, migration and secretion pivotal in pathogenesis of lung diseases Increase in number & enlargement accommodate high particle load Particle overload and disintegration release of particles & initiation of lung injury

  9. Functional Alteration of AM High acid phosphatase activity – activation of AM Release of elastase by AM– degradation of elastin leading to emphysema Heavy Iron deposition in AM – covert pulmonary hemorrhage?

  10. Sputum Cytology Alterations - 1 Control Biomass user Eosinophilia allergy bronchitis asthma Neutrophilia airway obstruction & Inflammation Lymphocytosis viral infection - Cells / hpf Cells / hpf Cells / hpf

  11. Sputum Cytology Alterations - 2 Control Biomass user Metaplasia with atypia carcinogen Insult & faulty repair-risk for COPD & lung cancer Ciliated columnar epithelial cells damage to thebronchial wall Koilocyte (with perinuclear halo) HPV infection % of individuals % of individuals % of individuals *p<0.05

  12. Nuclear Anomalies – biomarker of Genotoxicity Micronucleus MN / 1000 cells Control Biomass user

  13. Hematological & Immune Alterations Abnormal hematology • Decrease in Hb, RBC in 26% individuals • Increase in WBC in 30% • Increase in Platelet & P-selectin in 57% • Decrease in antioxidant in 52% cases Altered immunity • 31% supression of CD4+ Th, 27% increase in CD8+ Tc • CD4:CD8 ratio 2:1 1:1 • 47% decrease in CD19+ B cells • 98% increase in CD16+56+ NK cells P - selectin % of platelet Superoxide Dismutase U / ml Control Biomass user

  14. Summary • Exposure to biomass fuel emissions in rural women cause significant increase in : • Respiratory Symptoms • Lung Function Impairment • Numerical, Structural & Functional alteration of AM • Systemic alterations Genotoxicity Hematological & Metabolic alterations Immune alterations (vulnerable to infections) Some of these alterations are reversible & proper intervention measures can prevent the development of irreversible diseases like COPD & cancer

  15. The health consequences of millions of rural Indian women & children warrant immediate implementation of intervention measures – • cleaner energy options & alternative fuels • improved stoves • improved ventilation / chimneys • awareness campaigns on health & behavioral changes • early medical intervention to prevent diseases like tuberculosis, COPD, blindness & cancer

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