Scene1: A brick walled house in a narrow by lane of a typical urban slum of Lucknow. A small open veranda leads to two small, dingy and damp rooms, with no access to sunlight, and hardly any ventilation. One of the rooms doubles up as a kitchen, which has a chulha (mud stove) run on wood fuel. The smoke from the stove and from the bidis (cheap cigarettes) smoked by the family head lingers in the suffocating environs where Shiv Prasad, a daily wage labourer, his wife Ramdulari and his 4 children manage to eke an existence. Shiv Prasad underwent TB treatment 7 years ago (the cough has returned again) and his 6 years old son is currently on treatment for pulmonary TB.
Scene2: A mud house in a village bordering the district town of Gonda. A joint family of several members uses wood fuel stove, and the youngest member—three and a half month old Hasan--recently suffered from severe pneumonia and had to be shifted to a private hospital 150 kilometres away in Lucknow when the local doctors gave up on him. Fortunately the child survived.
Scene3: A modern 3 bed room apartment in a posh locality of a metro city inhabited by the Sharma family. The children’s rooms are air conditioned with very little scope for fresh air/sunlight to enter. Mr Sharma is an avid smoker and with smoking being banned in public places, he finds the closed confines of his home to be the most convenient place to satisfy his addiction. His 10 year old daughter Neha suffers from asthma and has to carry her inhaler in her school bag every day.
All these real life examples are bound by one or more of three common threads—polluted air circulating in the house from incomplete combustion of burning of solid biomass fuels like wood/coal/cow dung (used by 826 million Indians), poor ventilation and tobacco smoke (which releases more than 4,000 chemicals, of which at least 250 are harmful, and more than 50 are known to cause cancer). This endangers not only the smoker but also others present in the vicinity. Most of the acute respiratory infections (ARIs), which kill over I million Indians every year, are associated with indoor air pollution.
Dr Donald Enarson, who is expert on lung health, tuberculosis and indoor air pollution at the International Union Against Tuberculosis and Lung Disease (the Union), elaborates that, “Other causes (besides tobacco and bio fuel smoke) leading to respiratory diseases include overcrowding and poor ventilation that increase the concentration of harmful infectious and toxic agents indoors. In houses, offices and even in airplanes, when ventilation is reduced to seal the environment for cooling/heating purposes, it leads to an increase in respiratory and general illnesses called the sick building syndrome.”
Indoor air pollution is responsible for 2.7% of the global burden of disease. Three types of lung diseases have a strong association with solid fuel smoke: (i) acute lower respiratory infections (ALRIs) in children, (ii) chronic obstructive pulmonary disorder (COPD) in women, and (iii) lung cancer in women exposed to coal smoke. According to the World Health Organization, worldwide nearly 2 million people die each year from diseases caused by unhealthy cook stove technologies, including more than 1 million people, mostly women, dying from COPD. Nearly half of deaths among children under 5 years old from ALRIs are due to particulate matter inhaled from household solid fuels’ smoke and 1.5% of annual lung cancer deaths are also attributable to exposure to carcinogens from polluted indoor air.
Several children being treated for pneumonia at the Bahraich District Hospital and Nelson Hospital of Paediatrics and Neonatal Medicine Lucknow were found to be coming from families which used wood/charcoal cook stoves and where elders habitually smoked bidis/cigarettes, suggesting that cigarette and cook stove smoke increases the risk of pneumonia in children. The Acute Respiratory Infections Atlas confirms that indoor air pollution significantly increases the incidence of pneumonia which globally kills close to 1 million children under 5, each year.
Nearly half of the world’s children are exposed to tobacco smoke in their daily lives, which doubles their chances of developing ARIs. Foetuses are at special risk, and abnormal lung function at birth may result in more severe infections in infancy. Non-smokers who are exposed to tobacco smoke in the workplace or at home face a 25% to 30% greater risk of heart disease and a 20% to 30% greater risk of lung cancer.
Dr Ajay Misra, Managing Director of Nelson Hospital of Paediatrics and Neonatal Medicine feels that, “Even living in posh houses behind closed doors and windows, with no proper ventilation and flow of clean air, poses a danger to lung health.”
Professor Surya Kant, Head of the Pulmonary Department, King George’s Medical College, feels that, “Passive smoking and exposure to biomass smoke are also risk factors for developing active TB disease, especially in children. Cooking fumes and cigarette smoke can also trigger asthma attacks. So the practice of using biomass fuel should be replaced by other safer energy options. A house should be neat and clean, with proper ventilation and admit natural sun light and people should be made aware not to smoke inside homes or in presence of children.”
In the opinion of Dr. Kumud Anup, a practising paediatrician of Lucknow, “In urban areas tobacco smoke is a major source of indoor air pollution. Children are exposed to second hand smoke which is extremely dangerous and increases the risk of pneumonia. Tobacco smoke greatly increases the susceptibility to not only pneumonia but also asthma and several other lung infections.”
Yet, there is a dismal lack of awareness in the common public and even in the medical community about the ill effects of polluted air circulating in living spaces. Dr PK Mishra, a gynaecologist at the District Hospital, Bahraich, believes that, “Tobacco smoking or cooking on chulhas does not directly increase risk of childhood pneumonia. It can suffocate the child but it does not lead to any infection.”
Dr Enarson rightly insists that, “It is important to educate people about the dangers of open exposure to biomass and tobacco smoke so that they can take simple inexpensive precautions to reduce the problem. Shifting from biomass to liquid fuels is an important step forward but this may not be practical for very poor people. So it is best to do the cooking with biomass fuel either outside or in a separate room away from the main house. Improvements in ventilation (planning open windows or ventilation shafts under the eaves), using simple ‘enclosed stoves’ and preparing venting chimneys are practical ways to improve the situation. And the most crucial thing is to prevent people from smoking tobacco.”
Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also authored a book on childhood TB (2012), co-authored a book (translated in three languages) "Voices from the field on childhood pneumonia" and a report on Hepatitis C and HIV treatment access issues in 2011. Email: firstname.lastname@example.org, website: http://www.citizen-news.org)
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