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Environment
Original article
The association of household fine particulate matter and kerosene with tuberculosis in women and children in Pune, India
  1. Jessica L Elf1,2,3,
  2. Aarti Kinikar4,
  3. Sandhya Khadse4,
  4. Vidya Mave1,5,
  5. Nishi Suryavanshi5,
  6. Nikhil Gupte1,
  7. Vaishali Kulkarni6,
  8. Sunita Patekar6,
  9. Priyanka Raichur5,
  10. Mandar Paradkar5,
  11. Vandana Kulkarni5,
  12. Neeta Pradhan5,
  13. Patrick N Breysse3,7,
  14. Amita Gupta1,3,
  15. Jonathan E Golub2,3
  1. 1Department of Medicine, Division of Infectious Diseases, Center for Clinical Global Health Education, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  2. 2Department of Medicine, Division of Infectious Diseases, Center for TB Research, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
  3. 3Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  4. 4Pediatrics Department, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India
  5. 5Byramjee Jeejeebhoy Government Medical College-Johns Hopkins Clinical Trials Unit, Pune, India
  6. 6Byramjee Jeejeebhoy Government Medical College and Sassoon Government Hospitals, Pune, India
  7. 7Currently employed by the Centers for Disease Control and Prevention. Patrick Breysse is serving in his personal capacity.
  1. Correspondence to Dr Jessica L Elf, Center for Clinical Global Health Education, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; jessicaelf{at}gmail.com

Abstract

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.

  • air pollution
  • cooking fuel
  • social determinants
  • pm2.5

https://doi.org/10.1136/oemed-2018-105122

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    Footnotes

    • Contributors JLE: conceptualised and designed the study, obtained funding, managed study implementation, analysed and interpreted data, and drafted the initial manuscript. AK, SK, PNB: assisted with study design and reviewed and revised the manuscript. VM, NS, MP, VK and NP: assisted with study design and implementation, and reviewed and revised the manuscript. NG: assisted with study design and data analysis, and reviewed and revised the manuscript. VK, SP and PR: assisted with data collection instrument development, obtained data, and reviewed and revised the manuscript. AG and JEG: assisted with conceptualisation of study design, obtained funding, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

    • Funding Research reported in this manuscript was supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under award numbers R01AI097494 and UM1AI069465, and by the Fogarty International Center, Office of AIDS Research, National Cancer Center, National Heart, Blood, and Lung Institute, and the NIH office of Research for Women’s Health through the Fogarty Global Health Fellows Program Consortium comprised of the University of North Carolina, Johns Hopkins, Morehouse and Tulane under award number R25TW009340. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Data in this manuscript were also collected as part of the Regional Prospective Observational Research for Tuberculosis (RePORT) India Consortium. This project has been funded in whole or in part with Federal funds from the Government of India’s (GOI) Department of Biotechnology (DBT), the Indian Council of Medical Research (ICMR), the United States National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID), Office of AIDS Research (OAR), and distributed in part by CRDF Global. The contents of this publication are solely the responsibility of the authors and do not represent the official views of the DBT, the ICMR, the NIH, or CRDF Global. Any mention of trade names, commercial projects, or organisations does not imply endorsement by any of the sponsoring organisations. Research reported in this manuscript was also supported by the Ujala Foundation and the Gilead Foundation. Dr Aarti Kinikar was supported by the Fogarty International Center BJGMC JHU HIV TB Program D43TW009574.

    • Patient consent Obtained.

    • Ethics approval Ethics approval for this study was granted from the Institutional Review Boards of the Sassoon Government Hospitals and Byramjee Jeejeebhoy Government Medical College (SGH/BJGMC) in Pune, Maharashtra, India and the Johns Hopkins University School of Medicine in Baltimore, Maryland, USA.

    • Provenance and peer review Not commissioned; externally peer reviewed.