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Indoor Air Pollution and its Effects on Human Health in Ilam District of Eastern Nepal, 2015 1

NEPA

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ALTH RESEARCH CO

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ESTD. 1991

Nepal Health Research Council (NHRC)Ramshah Path, Kathmandu, NepalTel : +977 1 4254220Fax : +977 1 4262469E-mail : [email protected] Website : www.nhrc.org.np

Government of Nepal

Nepal Health Research Council

Indoor Air Pollution andits Effects on Human Health inIlam, Nepal2016

Indoor Air Pollution and its Effects on Human Health in Ilam District of Eastern Nepal, 20152

Report ofIndoor Air Pollution and its Effects on Human Health in

Ilam District of Eastern Nepal, 2015

Prepared by:

Government of Nepal

Nepal Health Research CouncilRamshahpath, Kathmandu, Nepal

2016


Study Team Members

Dr. Meghnath Dhimal

Dr. Khem Bahadur Karki

Dr. Krishna Kumar Aryal

Mr. Purushottam Dhakal

Mr. Hari Datt Joshi

Mr. Achuyt Raj Pandey

Mr. Sajan Puri

Dr. Pradip Gyawali

Dr. Narayan Bahadur Mahotra

Dr. Arun Kumar Sharma

Dr. Om Kurmi

Suggested citation: Dhimal M. , Karki KB, Aryal KK, Dhakal P, Joshi HD, Pande AR, Puri S, Gyawali P, Mahotra NB, Sharma AK, Kurmi O.2016. Indoor Air Pollution and its effects on Human Health in Ilam District of Eastern Nepal. Kathmandu: Government of Nepal, Nepal Health Research Council (NHRC)


AcknowledgementsI would like to offer my sincere thanks to Dr. Meghnath Dhimal, Principal Investigator of this research project who worked determinedly to bring this work in the present form. I am equally grateful to co-investigator of this study Dr. Krishna Kumar Aryal, Nepal Health Research Council ;Dr. Pradip Gyawali, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajung; Dr. Narayan B. Mahotara, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajung ; Dr. Arun Kumar Sharma, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajung ;Mr. Purushotam Dhakal, Nepal Health Research Council ;Mr. Achuyt Raj Pandey, Nepal Health Research Council ;Mr. Hari Datt Joshi, Nepal Health Research Council. I am also grateful to Dr. Om Kurmi, Co-Investigator, University of Oxford, Oxford, for his technical guidance in proposal development, report editing and supporting by providing Dust Trak air monitor instruments.

My special thanks go to data enumerators of this study Mr Ashish Khadayat, Ms. Sabita Paudel, Ms. Parbati Phuyal, Ms. Saika Khadka, Ms. Sova Adhikari, Ms. PratimaGautam, Ms Newton Maharjan, and GokarnaShrestha for their tireless work during data collection. I also thankful to Mr. Sajan Puri, who worked for preparing data collection tools,data collection and data management.

I would also like to thank Mr. Rajkumar Pokharel,Senior Public Health Administrator, DHO Ilam and Chief of Primary Health Care Center, Chief of Health post and Chief of Sub-health post, Female Community Health Volunteer and Local Leader and people of Ilam district for their help in collecting data. I am also thankful to all those who participated in the survey.

I also equally grateful to Ms. Arpana Pandit, Research Associate, Ms. Jasmine Maskey Research Associate, Mr. Bihungum Bista, Research Associate, Mr. Anil Poudyal, Research Associate and Trishna Acharya, Research Assistant of NHRC, who supported the study team in different phases of a research project.

I am also acknowledging the contribution of Mr. Nirbhay Kumar Sharma, Deputy Chief Admin Officer, NHRC, Mr. Subodh Kumar Karna, Deputy Chief Account Controller, NHRC, and other staffs for managerial, administrative and financial supports.

Last but not least, I would thank all who were involved in this research project directly and indirectly to make it successful.

Dr. Khem Bahadur Karki

Member-Secretary



LIST OF ABBREVIATION

NHRC Nepal Health Research Council (NHRC)PM2.5 Particulate Matter less than 2.5 micrometersWHO World Health OrganizationDPHO District Public Health OfficeVDC Village Development CommitteePHC Primary Health Care CenterPCA Principal Component analysisNDHS Nepal Demographic Health SurveyALRI Acute Lower respiratory InfectionARI Acute respiratory InfectionCOPD Chronic Obstructive Pulmonary DiseaseFCHVs Female Community Health VolunteersVDC Village Development CommitteeF/Y Fiscal YearHHs HouseholdsPM Particulate MatterRR Relative RiskSF Solid FuelCMR Child Mortality RateCOPD Chronic Obstructive Pulmonary DiseaseHHs HouseholdsIAP Indoor Air PollutionIMR Infant Mortality RateLPG Liquid Petroleum GasMOH Ministry of Health MS-Excel Micro-Soft ExcelSPSS Statistical Package for Social SciencesCI Confidence IntervalBMI Body Mass Index FEV Force expiratory VolumeFVC Force Volume CapacityPEFR Peak Expiratory Flow Rate MI Myocardial Infraction


TABLE OF CONTENTS

ACKNOWLEDGEMENT ...............................................................................................................ii

LIST OF ABBREVIATION ...........................................................................................................iv

EXECUTIVE SUMMARY ...........................................................................................................xiii

1.1 Background .........................................................................................................................1

1.2 Statement of the problem and rationale / justification .............................................................1

1.3 Conceptual framework ............................................................................................................3

1.6 Research hypothesis ................................................................................................................4

CHAPTER 2: METHODOLOGY ..................................................................................................5

2.1 Study site and its justification..................................................................................................5

2.1 Research method .....................................................................................................................5

2.2 Study variables ........................................................................................................................5

2.3 Type of study ...........................................................................................................................5

2.5 Study unit ................................................................................................................................5

2.6 Sampling methods / techniques ...............................................................................................6

2.7 Sample size calculation ...........................................................................................................6

2.8 Criteria for sample selection ...................................................................................................7

2.9 Data collection technique and tools ....................................................................................8

2.9.1 Air quality monitoring .....................................................................................................8

2.9.2 Health assessment ............................................................................................................8

2.9.3 Standard questionnaire tool ...........................................................................................10

2.10 Validity and reliability of the study tools ............................................................................10

2.11 Data processing and management .....................................................................................10

2.12 Statistical analysis ............................................................................................................... 11

2.13 Ethical consideration ........................................................................................................... 11

2.14 Limitation of the study ........................................................................................................ 11


CHAPTER3:RESULT ...................................................................................................................12

3.1.1Household and kitchen characteristics ................................................................................12

3.1.2 Size of door and window measurement .........................................................................13

3.1.3 Electric materials in household ......................................................................................14

3.1.4 Physical materials in household ....................................................................................14

3.1.5 Cattles in household .......................................................................................................15

3.1.6 Information about fuel type and cooking stove .............................................................16

3.1.7 Information about water purification and household sanitation ....................................17

3.1.8 Indoor pollution situation (PM2.5) ..................................................................................19

3.1.9Socio-demographic characteristics of study population .................................................20

3.1.10 Child nutritional status .................................................................................................23

3.2 Diseases and disease symptoms prevalence in children ........................................................24

3.2. Diseases and its symptom prevalence in children ...........................................................25

3.2.2 Relationship of diseases/disease symptoms with ethnicity of children .........................27

3.2.3 Relationship of diseases/disease symptoms in children and black smoke attachment in wall of kitchen ........................................................................................................................30

3.2.4 Relationship of diseases/disease symptoms in children and stove types .......................34

3.2.5 Relationship of diseases/disease symptoms in children and fuel types used for cooking/ lighting ....................................................................................................................................37

3.3.1 Relationship of BMI with age of participants and possible asthma like symptoms ......39

3.3.2 Relationship of cough related respiratory disease symptoms with indoor environmental factors, smoking habit and age of participants .......................................................................40

3.3.3 Relationship of possible asthma like symptoms with indoor environmental factors,age and smoking habit participants ...............................................................................................43

3.3.4 Relationship of indoor air pollutants and smoking habit of participants with Pulmonary Function Test ..........................................................................................................................45

3.3.6 Relationship of participants more than 40 years reporting breathlessness with indoor environmental factors, age and smoking habit .......................................................................51

CHAPTER 4: DISCUSSION ........................................................................................................54

CHAPTER5: CONCLUSION AND RECOMMENDATION ....................................................58


5.1 Conclusion .............................................................................................................................58

5.2Recommendations ..................................................................................................................59

REFERENCES ...............................................................................................................................60

ANNEXES ......................................................................................................................................62

1. Selected VDC and Ward ....................................................................................................62

2. Consent form .....................................................................................................................63

3. Household Questionnaire Tool ..........................................................................................67

4. Adult Questionnaire Tool ..................................................................................................81

5. Child Questionnaire Tool ..................................................................................................89


LISTS OF TABLE

Table 1: Household and kitchen Characteristics. .............................................................................12Table 2: Size of door and window ...................................................................................................13Table 3: Electric materials in household ..........................................................................................14Table 4: Physical materials in household .........................................................................................15Table 5: Cattles in household ...........................................................................................................15Table 6: Water purification method ..................................................................................................17Table 7: Observed PM2.5 value level compares to National Indoor air Standard of Nepal 2009 .....20Table 8: Ethnicity of household .......................................................................................................20Table 9: Sex and ethnicity distribution of child ...............................................................................21Table 10: Sex and ethnicity distribution of youth ............................................................................21Table 11: Age and ethnicity distribution of children ........................................................................22Table 12: Age and ethnicity distribution of youth ..........................................................................22Table 13: Child nutritional status .....................................................................................................23Table 14: Diseases and its symptoms prevalence in children ..........................................................24Table 15: Diseases and its symptoms precentage in children age group ≤15 years .........................25Table 16: Diseases and its symptoms precentage in children age group ≤15 years .........................26Table 17: Association between recent fever illness within last 2 weeks with ethnicity of Children 27Table 18: Association between recent ARI with ethnicity of children .............................................27Table 19: Association between recent ARI, possible pneumonia with Ethnicity of Children .........28Table 20: Association between possible bronchitis with ethnicity of Children ...............................29Table 21: Association between current wheeze with ethnicity of children ......................................29Table 22: Association between Recent Respiratory Infection with black smoke attachment in wall 30Table 23: Association between recent Acute Respiratory Infections with black smoke attachment in wall ...........................................................................................................................................30Table 24: Association between recurrent ARI symptoms with black smoke attachment in wall ....31Table 25: Association between anytime wheezing with black smoke attachment in the wall .........31Table 26: Association between current wheezing with black smoke attachment in wall ................32Table 27: Association between asthma like symptoms, with black smoke attachment in wall .......32Table 28: Association between possible bronchitis with stove in fan ..............................................34Table 29: Association between asthma like symptoms with pipe joined (chimney pipe) to stove ..34Table 30: Association between recent infection with fan used to stove...........................................35Table 31: Association between possible bronchitis with fanjointo stove ........................................35Table 32: Association between Recent ARI with types of stove......................................................36Table 33: Association between anytime wheeze with types of stove ..............................................36


Table 34: Association between possible bronchitis with fuel types .................................................37Table 35 : Association between recent infections with fuel types ...................................................37Table 36: Association between recent ARI with fuel types ............................................................38Table 37: Association between recent ARI, Possible pneumonia ....................................................38Table 38 : Diseases prevalence in adult ...........................................................................................40Table 39: Association between age categories and BMI..................................................................40Table 40: Association between BMI with possible asthma like symptoms .....................................41Table 41: Association between usual cough and age categories ......................................................41Table 42: Association between usual cough and smoking habit ......................................................42Table 43: Association between usual cough and pipe joining to stove ............................................42Table 44: Association between cough every day with pipe join to the stove...................................42Table 45: Association between usually cough and personal exposure to indoor air pollution ........43Table 46: Association between cough every day for more than 3 months with pipe join to stove ..43Table 47: Association between possible asthma like symptoms with age .......................................44Table 48: Association between possible asthma like symptoms with pipe joints to the stove ........44Table 49: Association between possible asthma like symptoms and personal exposure to indoor air pollution ...........................................................................................................................................45Table 50: Association between possible asthma like symptoms with fuel type...............................46Table 51: Association between possible asthma like symptoms with stove type ............................46Table 52: Association between Pulmonary function test with exposure duration ...........................47Table 53: Association between pulmonary function test with a smoking habit ...............................47Table 54: Association between pulmonary Function Tests with past smoking habit ......................47Table 55: Association between pulmonary function test with Fuel type .........................................48Table 56: Association between pulmonary function test with stove type ........................................48Table 57: Association between age of participants with Hypertension ..........................................49Table 58: Association between hypertension withUse of fuel type .................................................49Table 59: Association between hypertension with smoking habit ...................................................50Table 60: Association between hypertension with exposure duration .............................................50Table 61: Association between participants more than 40 years reporting breathlessness with age of participants .......................................................................................................................................51Table 62: Association between participants more than 40 years reporting breathlessness and fuel type ...........................................................................................................................................52Table 63: Association between participants of more than 40 years reporting breathlessness and exposure duration .............................................................................................................................52Table 64: Association between participants more than 40 years reporting breathlessness and smoking habit ...................................................................................................................................53


LIST OF FIGURES

Figure 1: Conceptual framework .......................................................................................................3

Figure 2: Stove types .......................................................................................................................16

Figure 3: Fuel type ...........................................................................................................................17

Figure 4: Sources of drinking water .................................................................................................18

Figure 5: Types of toilet ...................................................................................................................19


Solid biomass fuel is a principal source of energy used for domestic purposes in low and middle income country like Nepal. Household air pollution (mainly indoor air pollution) is a major risk factor associated with causing chronic obstructive lung disease in adult and acute respiratory infection in children. Furthermore, women and children are most vulnerable to indoor air pollution in Nepal compared to other groups. This study aims to assess the relationship between indoor air pollution and associated health effects in Ilam district of Eastern Nepal.

It was a cross-sectional comparative study. Six hundred households from 20 Village Development Committees (VDCs) were selected through multistage cluster sampling and household were selected during a systematic random sampling technique with the individual household member as the study unit. Investigator delivered structured questionnaire were used to acquire data on socio-demographic status, household characteristics, energy consumption and exposure to household air pollution. Particulate matter (PM2.5) was measured using a photometric device (DustTrak) and Lung function was measured using MIR SPIROLAB III spirometer. Body Mass Index (BMI) was calculated from the measured standing height and weight data. In addition, oxygen saturation, temperature of body, blood pressure and respiration rate were measured. Blood pressures were measured by an automatic sphygmomanometer. Respiratory morbidities were defined using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for chronic obstructive pulmonary disease (COPD) and the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire for asthma.

Out of 600 households, it was found that, 51 percent households used traditional stove, 29 percent mixed stove and 20 percent clean stove. Similarly, almost 59 percent household used wood, 38 percent mixed fuel and the remaining 3 percent household used clean fuel. There were 492 children in these households with 37.2 percent under 5 years of age. Approximately10.4 percent of children under 5 years of age had an acute respiratory infection within the last 2 weeks prior to the survey, 3.1 percent of children reported wheezing during the last 12 months and 6.6 percent had ever wheezed. Asthma like symptoms (wheezing, unremitting nocturnal cough and exercise induced cough) were reported by 4.1 percent children under 15 years of age during the last 12 months prior to the survey.

In this study, 1,533 adults of 15 to 100 years participated in the survey. The prevalence of COPD in population over 40 years of age was 3.2%, according to the GOLD spirometry criteria. Similarly

EXECUTIVE SUMMARY


about 3.1 percent of the study population had asthma like symptoms and 2.2 percent had spirometry results consistent with asthma (FEV1/FVC < 0.8). The participants from household using traditional fuel type reported significantly higher breathlessness prevalence compared to those who used to clean fuel (p <0.01).

Decrease in lung function capacity was found with increase in exposure to indoor air pollution, but need to confirm in a prospective study. Furthermore, Lung function, hypertension, asthma like symptoms were significantly associated with smoking habit, time of exposure to indoor air pollution of participants (p <0.01).

In conclusion, indoor air pollutant parameters are associated for respiratory health, illness and deficits in lung function.

Key words: Indoor Air Pollution, Respiratory Health, Lung Function Test


CHAPTER

INTRODUCTION

1

1.1 Background

Low and middle income countries (LMICs) are the main users of solid biomass fuels (wood, charcoal, crop residues, and animal dung etc.) for cooking and heating. Approximately three billion people worldwideuse solid fuel with over 4/5th from LMICs[1]. The fuels areoften burnt in 'three-stone cooking fires' (three stones in a triangle with a fire in the center) or simple traditional stoves without chimneys with incomplete combustionproducinghigh concentrations of particulate matter, carbon monoxide and other organic compounds [2]. The major health problems related to indoor air pollution (IAP) are respiratory diseases, cancers and eye diseases [3-6].

More than 80 percent of the Nepalese population reside in rural areas and majority of them uses biomass fuel for cooking and heating[7]. Although the world has moved into the cleaner technologies, with the increase in the awareness level about the effects of pollutants on human health, the rural residents of LMICS including continue to burn solid fuel and being exposed to very high airborne pollutants. The Ministry of Health (MoH) has recognized ARI including ALRI as one of the major public health problems among under 5 age group children (≤5) [8]. In Nepal, acute respiratory infection (ARI), including acute lower respiratory infection (ALRI)isthe leading causes of childhood morbidity and mortality with significant increase in its incidence over the last few decades[9].A study conducted in Dhading district in Nepal in 2009 reported that about 87 percent of households used solid biomass fuel as a primary source of fuel at the time of the survey andattributed 50% of ARI, mainly ALRI or pneumonia to use of solid fuel[9].

1.2 Statement of the problem and rationale / Justification

There are few published studies related to householdair pollution and its effects on health in Nepal. However, generalizability among the published studies is limited due to their different study designs. There is limited availability of data in Nepal for the estimation of burden of disease due to household air pollution[10]. However,some epidemiological studies have reported significant positive associationbetween the prevalence of chronic bronchitis and average amount of time of exposure to domestic smoke pollution both amongst the smokers and non-smokers in the rural hilly region of Nepal[11]. In addition, household characteristics like door size, window size, and type of stoves, types of kitchen, and fuel types are also considered environmental factors affecting


household pollution level and health effect [12]. Although majority of the Nepalese population particularly from remote hilly region use biomass fuel but there islimited data on health risk associated withpoorlyventilatedkitchen, use of low quality fuels for the cooking purpose, and use of traditional stove. Despite several governmental and nongovernmental organizations are exerting their efforts on reducing the exposure to indoor air pollutants through promotion of biogas or improved cooking stove (ICS) but their effectiveness is questionable. Therefore, this study will generatea database on what is the situation of the health condition of the local people and how it is related to the indoor air pollution and kitchen characteristics. Thus, this study will prove to be adatabase for a research lacking area. Our study aims to generate evidence on the effects of indoor air pollution, for similar geographical and socio- cultural communities of Eastern Region districts. Moreover, the database can also work as baseline information required for future intervention study.

1.3 Conceptual framework

The study was conceptualized from the perspective that household air pollution arises from use of wood fuel, which is a major source of energy for cooking by most rural households although few uses cleaner fuel such as liquefied petroleum gas (LPG) in Ilam. Personal exposure to indoor air pollution depends upon a host of factors such as fuel types, stove used, kitchen location, ventilation and most importantly, by the amount of time individuals spend in polluted environments.

This is illustrated in Figure

Figure 1: Conceptual Framework


1.5 Research objectives

General

To study the respiratory effects of indoor air pollution in the population of Ilam district of Nepal.

Specific

Assessment of pollutant-exposure influencing parameters (Fuel types, stove types, door and window size at the kitchen.

To measure 24 hours PM2.5 in households.

To assess the respiratory illness, respiratory symptoms, and pulmonary function among household members.

To find out the association between respiratory health problems and household indoor air pollutants.

To measure the systolic and diastolic blood pressure of household members.

To determine the association between indoor air pollution and hypertension.

1.6 Research hypothesis

Exposure to Indoor Air pollution is significantly associated with respiratory illness and blood pressure.


CHAPTER

METHODOLOGY

2

2.1 Study site and its justification

Ilam is a hilly district of Mechi zone situated in eastern region of Nepal with an area of 1,703 square kilometer. The elevation ranges from 300 meters ((1,000 ft) to 4,000 meters (13,100 ft) altitude. In a year, five different types of climates from lower tropical, upper tropical, subtropical, temperate to subalpine are found in the district. About 290,254 people live in Ilam as per National Population and Household Census 2011. The district was selected as a study site because of its heterogeneity in population demographics (mixed ethnic groups),used of mixed cooking system(traditional and modern types), the cooking styles, altitudinal variation and household characteristics which resembles to other parts of the country. To our knowledge, there is no such previous study conducted in the district[14].

2.1 Research method

This was a quantitative study.

2.2 Study variables

i) Independent variables: Socio demographic characteristics, economic status, indoor air quality (PM 2.5), Household characteristics, Ventilation coefficient, Lifestyle related factors (smoking, alcohol), Immunization history of children, Anthropometric measurements.

ii) Dependent variables: Respiratory illnesses (ARI, COPD, Lung Cancer, Asthma, Bronchitis etc.), Blood Pressure.

2.3 Type of study

It was a cross sectional comparative study. In the study, we compared the health status of participants’ using cleaner fuel versus biomass fuel and ICS vs traditional stoves.

2.5 Study unit

Individual person of a household was the study unit.


2.6 Sampling methods / techniques

In total, 20 Village Development Committees (VDCs) were selected through multistage cluster sampling and 30 households were selected using a systematic random sampling technique in each 20 wards.

2.7 Sample size calculation

Altogether, data were collected from 600 households for this study. Thirty households were selected from each ward of the VDC or cluster. All individuals within the household were offered for health checkups. The selected VDCs and their wards are listed in Annex I. Sample size calculation procedure is explained below.

Sample size calculation:

n=z*p (1-p)/pq

Step 1: Initial calculation:

n=3.8416* (0.5*(1-0.5))/ 0.05*0.05=384.16

Step 2:Finite Population Correction (FPC) was not needed because initial n calculated was not 10% or more of the size of the majority of the age groups.

Step 3: Initial calculated n was multiplied by the design effect and number of age-sex estimates:

n=384.16 *1.5*1= 576.24

Step 4: Expected non-response was adjusted to get our final sample size:

n=576.24/0.95=606.56

Hence, the final sample size is 600 households with rounding from 606.56 sample value.

Where,

n = sample size

Level of Confidence Measure =1.96

Expected Response Rate = 0.95

Design effect (Deff) = 1.5

Baseline levels of the indicators = 0.5

Margin of Error (MOE) =0.05

Number of age/sex Estimates =1


2.8 Criteria for sample selection

Inclusion criteria:

• Households having cooking system inside house/kitchen

• Spirometry test was conducted on healthy person of age above 5 and below 100 years

Exclusion criteria:

• Household with the location of kitchen, outside home or those with outdoor cooking

• Household not cooking food in the home or consuming food items from the hotel on a regular basis (for more than a week in one month)

• Households operating using the same kitchen for business purpose, such as running a hotel/restaurant

• Recently operated patients or who have experienced Myocardial Infarction (MI)

• Children under five years

1.9 Data collection technique and tools

2.9.1 Air quality monitoring

The UCB particle monitor was used to measure particulate matter with an aerodynamic diameter less than 2.5 (PM2.5)indoors.Respirable dust or PM2.5was measured in 51 dwellings using different photometric devices (DustTrak 8520 and SidePak AM510;TSI Inc., Shoreview,MN, USA). Ventilation size was assessed through measuring the ventilation size of the household.

2.9.2 Health assessment

A. Pulmonary function measurements

Before conducting a spirometry, research participants were given instructions about the procedures and side effects of the test. The subjects were recommended not to wear tight clothing that may interfere or make it difficult to take a deep breath. And they were also requested not to eat a large meal, drink alcohol, or do vigorous exercise for a few hours before the test.

The person being tested was asked to take in a full breath and then seal their lips around the mouthpiece of the spirometer. The person then had to blow out as hard and fast as possible for at least six seconds, which is the approximate time it takes for normal lungs to empty. A nose clip was applied to ensure no air escapes from the nose.

This routine was repeated at least three times to ensure that the test was done correctly and to ensure accuracy of the results. Pulmonary function was measured in the field using a portable spirometer


MIR spirolab III and was assessed based on FEV1, FVC, FEV1/FVC and PEFR expressed as percent predicted for the age, sex, height, weight and race. Spirometry was conducted in sitting position using MIR SPIROLAB III spirometer based on American Thoracic Society (ATS) recommendations. Body temperature and pressure saturation (BTPS) was autocorrected by the MIR SPIROLAB II spirometer. Household members from each selected household performed the spirometry. The participants, who was suffering from any health ailments or recently operated patents or who have experienced Myocardial Infarction and child age below five years were excluded from spirometric measurements. The spirometers were calibrated periodically as per instructions provided in user manual.Field workers were trained by the pulmonologists before starting actual field work.

B.Physical measurement:

Standing height and weight were measured, which were used to calculate the body mass index (BMI). Weight was measured with a portable digital weighing scale. The instrument was placed on a firm, flat surface. Participants were requested to remove their footwear and socks, to wear lighter clothes and to stand on scale facing forward and arms at side with one foot on each side of the scale and to wait until asked to step off. The weight was recorded in kilograms. The height was recorded in centimeter. Height was measured with a portable standard stature scale. For the height measurement, research participants were asked to remove footwear and any hat or hair ties. Participants stood on a flat surface facing the interviewer with their feet together and heels against the backboard with knees straight. They were asked to look straight ahead and not to tilt their head up, making sure that their eyes were same level of their ears. Body mass index was calculated using following formula.

Body Mass Index (BMI) = Weight (KG)/ {(Height (m)} 2

C. Blood pressure measurements

An automatic blood pressure monitor was used to measure systolic and diastolic blood pressure (SBP and DBP) in the right arm of each participant in a calm sitting position. Before taking the measurement, participants were asked to sit quietly for about 15 minutes. And then, systolic and diastolic blood pressure was obtained.

D. Body temperature measurement:

The digital portable thermometer was used to measure body temperature of participants for both child and adult. Participants were requested to sit on a chair at least five minutes before using a thermometer. In addition, participants were requested to wait at least 15 minutes after bathing or exercising before taking an axillary temperature. A thermometer was put in the center of the participant's armpit and was requested to hold the arm down tightly in place at least five minutes until it beeps. After five minutes thermometer was removed from the participant's armpit and recorded its reading. Temperatures were recorded in Fahrenheit degree centigrade.


E. Oxygen saturation:

Oxygen saturation in blood was measured using pulse oximeter.

2.9.3 Standard questionnaire tool

Face to face interview of the research participants using three structured questionnaires were developed for this research.

Questionnaires were developed in three perspectives

• The first questionnaire was related about information on household demographic structure

• The second questionnaire was related to IAP monitoring.

• The third questionnaire was related about information on respiratory health assessment.

2.10 Validity and reliability of the study tools

Validity and reliability of the study tools were given major concern. Questionnaire was pretested in 10% of the estimated sample size. Questionnaires were translated to Nepali language to make the tools, understandable to the research participants.

The study used face to face structured interviews for the data collection from the households. The research instruments were developed by considering the contents of various research tools that were developed previously by different researchers. But the contents were contextualized and refined as needed. The final draft of the instruments was translated into Nepali and re-translated into English so that the notion of the study remains unchanged.

2.11 Data processing and management

Each question in the research instruments (questionnaire tool) was coded after completing the data collection. The responses of questionnaires from the field were checked and rechecked for the completeness and data verification. Then, raw data entered into the data entry program; Epi Data. After the entry was completed, the data were then transferred to SPSS 16.0 for further process. Once the data archived in SPSS, health data reported in spirometry was matched with health data reported in questionnaire sheet for further checking for its completeness and clearing. The information was then decoded wherever applicable.

2.12 Statistical analysis

Descriptive analysis like frequency, percent, mean and median was calculated. Bivariate statistical analyses were done. The findings were presented in text, tables, bar charts, pie charts.

2.13 Ethical consideration

Ethical approval was taken from the Ethical Review Board (ERB) of the Nepal Health Research


Council for conducting the study. While conducting the research in the field level, consent was taken from all research participants. First, the participants were briefed on the objectives, procedure and the importance of the research before taking the response of questionnaire tool. In addition, participants were informed that their participation is voluntary, and they can decide whether to participate or not in the study. If he/she could not participate in this study, research assistants requested next person from same household. Furthermore, if the participants were suffering from any health problems or they had surgery of body parts, those were excluded for study participation.Participants were prior informed that they could withdraw his or her participation from the study at any time if they do not wish to continue to participate in the study.

2.14 Limitation of the study

This study is limited to one hilly district of eastern Nepal. The findings may not be comparable to other parts of the country. In addition, due to the malfunctioning of Dust Trakequipment, in high altitudes and power shortage, air pollution monitoring of PM2.5 is limited to few households.


CHAPTER

RESULT

3

3.1.1Household and kitchen characteristics

Among the different households sampled in our study, majority had separate kitchens (77.7%) and 80.88 percent had black smoke on the kitchen's walls. Furthermore, 10.33 percent of households used joined pipe and 1.16 percent were used fan in the stove.Majority (59.33 %) of the household cooked on the ground floor. Looking at the construction materials, the majority of households used earth/sand (75.67%) in the floor and 32 percent household were found using bamboo in the outer wall of house with mud and followed by cardboard (15.33%). In case of watch materials used in roof, around 94.67 percent household used galvanized sheet followed by Plam/Bamboo, Cement, Tham and plam leaf, wood planks and wood.

Table 1: Household and kitchen characteristics.

Characteristics Variables Frequency (n) Percent (%)

Separate kitchen Yes 466 77.7

Attachment of black smoke in walls Yes 478 80.88

Stove joined to any pipe Yes 62 10.33

Fan in Stove Yes 7 1.16

Cooking stove joined in the floor

Ground floor 356 59.33

First floor 244 40.67

Total 600 100

Direction of door of kitchen

Inside 451 76.31

Outside 135 22.84

Both side 'out and in' 5 0.85

Total 600 100


Number of holes using for cooking in stove

One 248 41.33

Two 336 56

Three 16 2.67

Total 600 100

Direction of chimney in house

Facing towards home 10 3.33

Facing outwards home 290 96.67

Total 300 100

Material used in outer wall of house

Cane/Plam/Trunks 1 0.17

Mud/Sand 22 3.67

Bamboo with mud 192 32

Stone with mud 103 17.17

Plywood 2 0.33

Cardboard 92 15.33

Reused wood 68 11.33

Cement 52 8.67

Bricks 7 1.17

Cement blocks 40 6.67

Wood planks/shingles 21 3.5

Total 600 100

Materials used in floor

Earth/Sand 454 75.67

Wood planks 73 12.17

Cement 73 12.17

Total 600 100

Material used in roof Tham and plam leaf 5 0.83

Plam/Bamboo 12 2.00

Wood planks 5 0.83

Galvanized sheet 568 94.67

Wood 2 0.33

Cement 8 1.33

Total 600 100


Window size Small 102 28.73

Moderate 195 54.93

Sufficient 58 16.34

3.1.2 Size of door and window measurement

The average door size was1.36 m2 which is smaller than the minimum recommended size of 1.4 m2and window sizes was 0.17 m2.

Table 2: Size of door and window

Household Components N u m b e r household

Minimum(Area in m2)

Maximum(Area in m2)

Mean(Area in m2)

Recommendedsize (Area in m2)

Door 600 0 m2 11.54801 m2 1.36 m2 1.4 m2

Window 599 0 m2 3.09195 m2 0.17 m2

3.1.3 Electric materials in household

Multiple response frequency tables of electrical materials in household indicate that there were 5,220 responses to this series of question. Bed, electricity, table, mobile phone, chair, radio,and T.V were found in maximum number of households, (Table 3).

Table 3: Electric materials in household

Electric materials at home TypesResponses

Percent of Cases*N Percent

Electricity 588 11.26 98Radio 507 9.71 84.5T.V. 477 9.14 79.5Mobile Phone 574 11.00 95.67PSTN Phone 34 0.65 5.67Refrigerator 19 0.36 3.17Table 585 11.21 97.5Chair 562 10.77 93.67Bed 595 11.40 99.17Sofa 83 1.59 13.83Cupboard 452 8.66 75.33Computer 44 0.84 7.33Watch 455 8.72 75.83Electric Fan 41 0.79 6.83Dhikki/Jato 204 3.91 34Total 5220 100 870

* Multiple response options


3.1.4 Physical materials in household

Watch were found in maximum number of home which was 98.96 percent response followed by cycle 6.61 percent as shown in the given table 4.

Table 4: Physical materials in household

Physical Materials Types Responses Percent of Cases*

N PercentWatch 569 84.80 98.96Cycle 38 5.66 6.61Motorcycle or Scooter 50 7.45 8.7Tempo (Three Wheeler) 3 0.45 0.52Gada/Tanga 1 0.15 0.17Car/Truck 10 1.49 1.74Total 671 100 116.7

* Multiple response options

3.1.5 Cattles in household

Cow/ox was found in maximum number of households which is 84.14 percent response followed by goat 59.64 percent response.

Table 5: Cattles in household

Cattles at home Types Cattles Responses Percent of Cases

N Percent

Buffalo 80 5.83 14.41Cow/ox 467 34.01 84.14Horse/Donkey 6 0.44 1.08Goat 331 24.11 59.64Cock 360 26.22 64.86Duck 10 0.73 1.8Pig/Pork 119 8.67 21.44Total 1373 100


3.1.6 Information about fuel type and cooking stove

Figure 2: Stove types

The main types of stoves used were traditional stove, mixed stove and clean stove. Traditional stove means an open hearth type of stove without chimney. Modern stove means ICS with chimney and clean stove means bio gas, electricity and LPG are used for cooking materials. Around 51 percent of households used traditional stove (open hearth), whereas 29 percent used mixed stove (traditional, modern with clean stove) and remaining 20 percent used modern with a clean stove.

Figure 3: Fuel type

Almost 59 percent of households used wood and 38 percent household used mixed fuel, and remaining 3 percent household used clean fuel (LPG, Biogas, electricity).


3.1.7 Information about water purification and household sanitation

3.1.7.1 Water purification method

Almost all houses (99.28%) boiled water for drinking, as a purification method which is followed by use of cloth (4.32%) and a very insignificant number of households also used water guard, SODIS, chlorination and sedimentation as purification method.

Table 6: Water purification method

Water PurificationMethods

Response Percent of Cases*

N PercentBoiling 551 90.33 99.28Chlorination 1 0.16 0.18Water Guard 10 1.64 1.8Use of Cloth 24 3.93 4.32SODIS 3 2.62 0.54Sedimentation 5 0.49 0.9Total 594 0.82 107.03

*Multiple responses

The available sources of water in the district have categorized as shown in Figure 4.Inaround 98 percent of households, water was available throughout the years.

Figure 4: Sources of drinking water

3.1.7.2 Types of toilet

Among 600 households, 49% had pit latrine with slab built, followed by flush latrine (47.17%) connected to septic tank and remaining were flush latrine connected to piped sewer system (2.83%), and ventilated improved pit latrine (0.33%) and pit latrine without slab/open pit (0.33%).


Figure 5: Types of toilet

3.1.8 Indoor pollution situation (PM2.5)

Out of 51 households monitored indoor air quality data, only 2 percent observation were below National Indoor Air quality Standard of Nepal 2009 for 24 hour average and 7.8 percent observation were found below National Standard for an hour average, as shown in Table 7.

Table 7: Observed PM2.5 value level compares to National indoor air standard of Nepal 2009

Categorization of monitored PM2.5 level with compared to National indoor air quality standard of Nepal 2009 for 24 hour average

Categories Observation (n) Percent (%)

0-60 1 2.0

61-14000 50 98.0

Total 51 100

Categorization of monitored PM2.5 level with compared to National Indoor Air Quality Standard of Nepal 2009 of 1 hour average

Categories Observation (n) Percent (%)

0-100 4 7.8

101-14000 47 92.2

Total 51 100


3.1.9Socio-demographic characteristics of study population

3.1.9.1 Household ethnicity of household

The majority of households (43.17%) were from Disadvantaged Janajatis followed by Upper Caste Groups, who constituted more than one third (41%) of the household. About 11.5 percent households were from relatively advantaged Janajatis and 4.33 percent were from the Dalit community.

Table 8: Ethnicity of household

Ethnicity of household Frequency (n) Percent (%)

Dalit 26 4.33

Disadvantaged Janajatis 259 43.17

Relatively advantaged Janajatis 69 11.5

Upper Caste Groups 246 41

Total 600 1003.1.9.2 Sex and ethnicity distribution of child and youth

The majority of child (48.37 %) were from Disadvantaged Janajatis which was followed by Upper Caste Groups, who constituted more than one third (39.02 %) of the child (Table 9). In case of youth participants in the study, about 45.40 percent youth populations were from Upper Caste Groups followed by Disadvantaged Janajatis groups (38.88%) as shown in the Table 10.

Table 9:Sex and ethnicity distribution of child

Ethnicity Sex

Children Male (%) Female (%) Total (%)

Dalit 14 (5.86) 23 (9.09) 37 (7.52)

Disadvantaged Janajatis 120 (50.21) 118 (46.64) 238 (48.37)

Relatively advantaged Janajatis 10 (4.18) 15 (5.93) 25 (5.08)

Upper Caste Groups 95 (39.75) 97 (38.34) 192 (39.02)

Total 239 (100) 253 (100) 492 (100)

Table 10: Sex and ethnicity distribution of youthEthnicity Sex

Youth Male (%) Female (%) Total (%)

Dalit 24 (1.57) 28 (1.83) 52 (3.40)





Total 625 (40.77) 908 (59.23) 1533 (100)

3.1.9.3 Age and ethnicity distribution of child and youth

Out of 492 children around 62.80 percent were of age 6-14 years and remaining 37.20 percent were under 5 years. Similarly, about a half percent of all participated children were from disadvantage Janjati and remaining was from other caste as shown in given below table. In the case of youth, more than fifty percent of children were from age group 15 to 40 and remaining were from other age groups. Nearly an equal number of children were participated from Disadvantaged Janajatis (41.55%) and Upper Caste Groups (41.88%).

Table 11: Age and ethnicity distribution of Children

EthnicityAge categories in year

Children Below 5 (%) 6-14 (%) Total (%)Dalit 12 (1.44) 12 (1.44) 24 (4.88)




Total 183 (37.20) 309 (62.80) 492 (100)

Table 12: Age and ethnicity distribution of youth

Age categories in year

Ethnicity 15-40 (%) 41-60 (%) 61-100 (%) Total (%)Dalit 30 (1.96) 25 (1.63) 1 (0.07) 56 (3.65)

Disadvantaged Janajatis 357 (23.29) 221(14.42) 59 (3.85) 637(41.55)

Relatively advantaged Janajatis 97(6.33) 69 (4.50) 33 (2.15) 199 (12.98)

Upper Caste Groups 353 (23.03) 228 (14.87) 60 (3.91) 641(41.81)

Total 837(54.60) 543 (35.42) 153 (9.98) 1533 (100)

3.1.10 Child nutritional status

Out of 142 samples response, 19.01 percent had low birth weight (≤2500 gram), and more than 80 percent child were born above normal weight (>2500 gram). Majority of mother (93.9%) reported breast feeding their new bornand among those who breast feeds, majority (86.3%) fed for about six


months and 13.7 percent fed for more than six months.

Out of 165 samples response,majority (95.2 %, n= 157) of babies were born after full term.Approximately 7.9 percent new born babies suffered from various health problems, whereas in 92.1 percent had no health concerns at the time of birth.Around 97 percent children had complete set of vaccination.

Table 13: Child nutritional status

Weight of child at birth Response/Frequency (n) Percent (%)

≤2500 gram 27 19.01

>2500 gram 115 80.95

Total 142 100

Breast feeding

Yes 155 93.9

No 10 6.1

Total 165 100

Feeding only mother's milk to child

≤ 6 months 140 86.3

> 6 months 22 13.7

Total 162 100

Baby was born after pregnancy of mother

9 months completed 157 95.2

8 to 9 months 7 4.2

Less than 7 month 1 0.6

Total 165 100

Health problems shown in newly born baby

Yes 13 7.9

No 151 92.1


Total 164 100

Given all vaccines to child

Yes 151 96.8

No 5 3.2

Total 156 100

3.2Diseases and disease symptoms prevalence in children

Among 492 children, 6.71 percent reported having a fever illness within the last 2 weeks, 7.5 percent had recent respiratory infection, 3.5 percent had ARI and bronchitis in 2.8 percent.

Table 14: Diseases and its symptom prevalence in children

Diseases/Disease symptoms Frequency (%) Percent (%)

Fever illness within last 2 weeks 33 6.71

Possible Infection within last 4 weeks (At least once) 35 7.11

Recent Respiratory Infection 37 7.5

Recent ARI 17 3.5

Recent ARI;Possible Pneumonia 5 1.00

Recurrent ARI 22 4.5

Recurrent ARI symptoms, probably respiratory allergy 12 2.4

Possible Bronchitis 14 2.8

Any time wheezing 32 6.5

Current wheezing 15 3.0

Asthma like symptoms 19 3.9

Current Asthma 1 0.4

Possible nasal allergy 4 0.8

Possible nasal and eye allergy 2 0.4

Allergic rhino conjunctivitis 1 0.2

Heart diseases 2 0.8

Hearing problems with ear pain and discharging water like pus 6 1.2

Sample size 492 100


3.2.Diseases and its symptom prevalence in children

Table 15: Diseases and its symptoms percentage in children age group ≤15 years

Diseases/Disease symptoms Frequency (yes) Percent (%)

Recent fever illness within last 2 weeks 33 20.25

Possible Infection within last 4 weeks 35 21.7

Total sample response 161

Recent Respiratory Infection 37 22.98

Recent Acute Respiratory Infection 17 10.4

Total sample response 163

Out of 172 children of age group ≤ 5, Asthma like symptoms were found in 7.56 percent children,and out of 293 children of age group 6-14, asthma like symptoms were revealed in 2.05 percent.And out of 181, current wheezes were seen in 4.97 percent in children of age group ≤ 5 and 1.96 percent in children of age group 6-14 years. Furthermore, out of 130 children of age group ≤ 5, possible bronchitis were revealed in 3.85 percent and out of 192 children of age group of 6-14, possible bronchitis was revealed in 4.69 percent. About 8.84 percent children of age group ≤ 5, were suffering from any time wheeze out of 181 and out of 307 children age of 6-14, anytime wheeze was found in 5.21 percent.

Table 16: Diseases and its symptoms percentage in children age group ≤15 years

Age ≤ 5 years Age group 6-14 years

Diseases/disease symptomsFrequency

(yes)Percent (%)

Total sample

response

Frequency (yes)

Percent (%)

Total sample

responseAsthma like symptoms 13 7.56 172 6 2.05 293

Current wheezes 9 4.97 181 6 1.96 306

Possible Bronchitis 5 3.85 130 9 4.69 192

Anytime wheeze 16 8.84 181 16 5.21 307

3.2.2Relationship of diseases/disease symptoms with ethnicity of children

Table17 shows the distributions of recent fever illness among ethnic group. Recent fever illness within last 2 weeks in Dalit were 36.36 percent out of hundred percent, which were followed by Disadvantaged Janajatis, relatively advantaged Janajatis and Upper Caste Groups as shown in given below. The association of recent fever illness within last 2 weeks between ethnicity is not found statically significant.


Table 17: Association between recent fever illness within last 2 weeks with ethnicity of children

Child Recent fever illness within last 2 weeks p-value

None (%) Yes (%) Total (%) 0.203

Dalit 7 (64.64) 4 (36.36) 11 (100.00)




Total 130 (79.8) 33 (20.2) 163 (100.0)

Recent Acute Respiratory Infections in Dalit, Disadvantaged Janajatis and Upper Caste Groups were revealed in 27.27 percent, 13.51 percent and 5.88 percent respectively. The association between Recent ARI and ethnicity is not found statistically significant.

Table 18: Association between recent ARI with ethnicity of children

Recent Acute respiratory Infection p-valueChild ethnicity Yes (%) None (%) Total (%)

Dalit 3 (27.27) 8 (72.73) 11 (100.00)

0.085




Total 17 (10.43) 146 (89.57) 163(100.00)

Recent ARI, possible pneumonia was revealed 30 percent in Dalit out of ten participants and 2.86 percent in Disadvantaged Janajatis out of seventy participants. Recent ARI, possible pneumonia was not found in relatively advantaged Janajatis and upper caste groups. The association between recent ARI with possible pneumonia and ethnicity is found statistically significant.

Table 19: Association between recent ARI, possible pneumonia with ethnicity of children

Recent ARI, Possible pneumonia p-valueChild ethnicity Yes (%) None (%) Total (%)

0.002

Dalit 3(30.00) 7(70.00) 10(100)

Disadvantaged Janajatis 2(2.86) 68(97.14) 70(100)

Relatively advantaged Janajatis 0(0.00) 10(100.00) 10(100)

Upper Caste Groups 0(0.00) 66(66.00) 66(66 )Total 5(3.21) 151(96.79) 156(100)


Out of 31 Dalit participants, possible Bronchitis were found in 9. 68 percent. Similarly, in 142 Disadvantaged Janajatis participants disease were shown in 6.34 percent and only 1.54 percent participants from Upper caste were suffered. The association between possible bronchitis and ethnicity were not statistically significant.

Table 20: Association between possible bronchitis with ethnicity of children

Possible Bronchitis p-value

Child ethnicity Yes (%) None (%) Total (%)

0.07

Dalit 3 (9.68) 28 (90.32) 31 (100)

Disadvantaged Janajatis 9 (6.34) 133 (93.66) 142 (100)

Relatively advantaged Janajatis 0 (0.00) 19 (100.00) 19 (100)

Upper Caste Groups 2 (1.54) 128 (98.46) 130 (100)

Total 14 (4.35) 308 (95.65) 322 (100)

Out of 37 Dalit participants, wheezing disease symptoms were found in 8.11 percent participants, the wheezing prevalence was found in 3.16 percent out of 190 upper caste children under age 15.Similarly, out of 236 Disadvantaged Janajatis participants, wheezing prevalence was found in 2.54 percent participants and relatively advantaged Janajatis were not found to suffer from wheezing diseases.

Table 21: Association between current wheeze with ethnicity of children

Current Wheeze p-value

Child ethnicity Yes (%) None (%) Total (%)

0.24

Dalit 3(8.11) 34(91.89) 37(100)

Disadvantaged Janajatis 6(2.54) 230(97.46 ) 236(100)

Relatively advantaged Janajatis 0(0.00) 24(100.00) 24 (100)

Upper Caste Groups 6(3.16) 184(96.84) 190(100)

Total 15(3.08) 472(96.92) 487(100)

3.2.3Relationship of diseases/disease symptoms in children and black smoke attachment in wall of kitchen

Recent Respiratory Infection was found in 23.57 percent children in out of 140 who were living in home, having attachment of black smoke on wall of kitchen and this disease symptoms were shown in 17.39 percent in out of 23 children who were living in home have not attachment of black smoke on wall of kitchen.


Table 22: Association between recent respiratory infection with black smoke attachment in wall

VariableRecent Infection p- value

Yes (%), At least once

None (%) Total (%)

0.620Black smoke attachment in walls

Yes 33 (23.57) 107 (76.43) 140 (100)

No 4 (17.39) 19 (82.61) 23 (100)Total 37( 22.70) 126 (77.70) 163 (100)

Recent ARI were revealed in 11.43 percent in out of 140 children having age who were living at home, having an attachment of black smoke on wall of kitchen and recent ARI disease symptoms were shown in 4.35percent in out of 23 children who were living in home having not attachment of black smoke on wall of kitchen.

Table 23: Association between recent acute respiratory infections with black smoke attachment in wall

Recent ARI p- valueBlack smoke attachment in walls Yes (%) No (%) Total (%)

0.471Yes 16 (11.43) 124 (88.57) 140 (100)

No 1 (4.35) 22 (95.65) 23 (100)

Total 17 (10.43) 146(89.57) 163(100)

Recurrent ARI symptoms were found in 5.50 percent, in out of 400 children under age 15, who were living at home, having attachment of black smoke on wall of the kitchen, however there were not shown any case of recurrent ARI symptoms in children under age 15 who were living in home having not attachment of black smoke on wall of kitchen.

Table 24: Association between recurrent ARI symptoms with black smoke attachment in wall

Recurrent ARI symptoms p- valueBlack smoke attachment in walls Yes (%) No (%) Total (%) 0.034

Yes 22 (5.50) 378 (94.50) 400 (100)

No 0 (0.00) 78(100.00) 78(100)

Total 22 (4.60) 456 (95.40) 478 (100)

Anytime wheeze were found in 5.72 percent in out of 402 children, who were living at home, having attachment of black smoke on wall of kitchen, however, anytime wheeze were found in 11.11percent in out of 81 participants who were living at home having not attachment of black smoke on wall of kitchen.


Table 25: Association between anytime wheezing with black smoke attachment in the wall

Anytime wheezing p- valueBlack smoke attachment in walls Yes (%) No (%) Total (%)

0.075Yes 23 (5.72) 379 (94.28) 402 (100)

No 9 (11.11) 72 (88.89) 81 (100)

Total 32 (6.63) 451 (93.37) 483 (100)

Current wheeze was found in 3.49 percent out of 401 children, who were living at home, having an attachment of black smoke on wall of kitchen, and current wheeze were found in 1.23 percent in out of 81 participants who were living in home having not attachment of black smoke on wall of kitchen.

Table 26: Association between current wheezing with black smoke attachment in wall

Current wheezing p- valueBlack smoke attachment in walls Yes (%) No (%) Total (%) 0.075

Yes 14 (3.49) 387(96.51) 401(100)

No 1(1.23) 80(98.77) 81(100)

Total 15(3.11) 467(96.89) 482(100)

Asthma like symptoms were found in 4.46 percent out of 381 children, who were living at home, having an attachment of black smoke on the wall of the kitchen, and Asthma like symptoms were found in 2.53 percent out of 79 participants who were living in home having not attachment of black smoke on wall of kitchen.

Table 27: Association between asthma like symptoms, with black smoke attachment in wall

Asthma like symptoms p- valueBlack smoke attachment in walls Yes, at least

once (%)None (%)

(%)Total (%)

0.755

Yes 17(4.46) 364(95.54) 381(100)

No 2(2.53) 77(97.47) 79 (100)

Total 19(4.13) 441(95.87) 460(100)

3.2.4Relationship of diseases/disease symptoms in children and stove types

Possible Bronchitis were found in 2.86 percent out of 35 participants, who were living at home, having pipe join to stove and around 4.53 percent were suffered in out of 287 participants from possible bronchitis who were living in the home have not pipe join to stove.


Table 28: Association between possible bronchitis with stove in fan


Yes (%) None (%) Total (%)

1.0

Pipe joins to the stove Yes 1 (2.86) 34 (97.14) 35 (100)

No 13 (4.53) 274 (95.47) 287 (100)

Total 14 (4.35) 308 (95.65) 322 (100)

Asthma like symptoms were revealed in 4 (10.00%) out of 40 participants, who was living at home, having pipe join to stove and around 15 (3.53%) out of 425 participants, who were living at home, have not pipe join to stove.

Table 29: Association between asthma like symptoms with pipe joined (chimney pipe) to the stove

Asthma like symptoms p-value

Yes (%) None (%) Total (%) 0.87

Fan use in stove Yes 4 (10.00) 36 (90.00) 40 (100)

No 15 (3.53) 410 (96.47) 425 (100)

Total 19 (4.09) 446 (95.91) 465 (100)

Recent infection was revealed in 2 out of 2 participants, who were living at home, where fan was used in stove to emit pollution outside kitchen where as in 21.74 percent children were suffered from recent respiratory infection, who living at home have not this technique.

Table 30: Association between recent infection with fan used to stove

Recent infection p-value

Yes, At least once (%) None (%) Total (%) 0.05

Fan use in stove Yes 2 (100.00) 0 (0.00) 2 (100)

No 35 (21.74) 126 (78.26) 161(100)

Total 37 (22.70) 126 (77.30) 163 (100)

Possible Bronchitis were not found in the children who were living at home, where fan used in stove to emit pollution outside kitchen where as possible bronchitis were found in 4.35 percent out of 318 children, where fan were not used in stove to emit pollution from kitchen.


Table 31: Association between possible bronchitis with fan join to stove

Possible bronchitis p-valueYes (%) None (%) Total (%)

1.0*Fan Joint in stove Yes 0 (0.00) 4 (100.00) 4 (100.00)

No 14 (4.35) 304 (94.41) 318 (98.76)Total 14 (4.35) 308 (95.65) 322 (100.00)

*Fisher's Exact Test

Recent ARI was found in 9.20 percent out of 87 children who were taken from traditional stove user household, it was 14.58 percent in out of 48 children who were taken from mixed stove user household and recent ARI were found in 7.14 percent in out of 28 participants who were from clean fuel.

Table 32: Association between recent ARI with types of stove

Recent ARI p-valueYes (%) None (%) Total (%)

0.50

Types of stove Traditional 8 (9.20) 79 (90.80) 87 (100)

Mixed 7 (14.58) 41 (85.42) 48 (100)

Clean 2(7.14) 26 (92.86) 28 (100)Total 17 (10.43) 146 (89.57) 163 (100.00)

Anytime wheeze were revealed in 6.68 percent out of 404 children who were taken from the Unclean stove (Traditional + Mixed) user and it was seen in 5.95 percent out of 84 children who were from the clean fuel user.

Table 33: Association between anytime wheeze with types of stove

Anytime wheeze p-value

Stove type Yes (%) None (%) Total (%)

1.0*

Unclean stove 27 (6.68) 377 (93.32) 404 (100)

Clean stove 5 (5.95) 79 (94.05) 84 (100)Total 32 (6.56) 456 (93.44) 488 (100)


3.2.5Relationship of diseases/disease symptoms in children and fuel types used for cooking/ lighting

Possible Bronchitis were seemed in 3.66 percent, out of 191 children participants, who were represented from fuel wood user household, and around 5.69 percent out of 123, who were mixed fuel user, and no any case of possible bronchitis were found in clean fuel user.


Table 34: Association between Possible Bronchitis with fuel types



0.58

Stove type Wood 7 (3.66 ) 184 (96.34) 191 (100.00)

Mixed 7 (5.69) 116 (94.31) 123 (100.00)

Clean 0 (0.00) 7 (100.00) 7 (100.00)Total 14 (4.36) 307 (95.65) 321 (100.00)

Out of 158 children participants, recent infection was found in 23.42 percent, who were from an unclean fuel (wood and mixed) user, and recent infection was not seen in out of 4 participants, who were participated from clean user.Table 35:Association between recent infections with fuel types

Recent infection P-value

Yes, At least once (%) None (%) Total (%) 0.3

Fuel type Unclean 37 (23.42) 121 (76.58) 158 (100)

Clean 0 (0.00) 4 (100.00) 4 (100)Total 37 (22.84) 125 (77.16) 162 (100)

Among 162 children participants, recent ARI was found in 10.76%, who were from unclean fuel user, and recent ARI were not seen in clean user participants

Table 36: Association between recent ARI with fuel types

Recent ARI p-valueYes (%) None (%) Total (%) 0.63*

Fuel type Unclean fuel 17 (10.76) 141 (89.24) 158 (100)

Clean fuel 0 (0.00) 4 (100.00) 4 (100)Total 17 (10.49) 145 (89.51) 162 (100)


Out of 151 children participants, recent ARI, possible pneumonia were in 3.31 percent in unclean fuel user and the disease prevalence in children were not found in clean fuel user.

Table 37: Association between recent ARI, possible pneumonia

Recent ARI, possible pneumoniap-value

Yes (%) None (%) Total (%)Fuel type Unclean 5 (3.31) 146 (96.69) 151 (100.00) 1.0*

Clean 0 (0.00) 4 (100.00) 4 (100.00)Total 5 (3.23) 150 (96.77) 155 (100.00)



3.3 Diseases and diseases symptom prevalence in adult

The table given below presents the prevalence of diseases and disease symptoms in adult (≥ 15 years age).As per GOLD, COPD definition community based COPD prevalence in population above 40 years of age, was 3.2%, with reproducible and acceptable spirometry data. Similarly about 3.1 percent of the study population had some asthma like symptoms and 2.2 percent had spirometry findings consistent with asthma (FEV1/FVC < 0.8). And current asthma was found in 2.9 percent population of ≥ age 15.

Table 38: Diseases prevalence in adult

Diseases/Disease symptoms Frequency Percent

COPD 23 3.2Possible asthma like symptoms 46 3.1

Current Asthma 43 2.9

3.3.1 Relationship of BMI with age of participants and possible asthma like symptoms

Among 1,496 participants, 184 participants were in 15-40 years age group, 532 were in 41-60years age group and 151 were in age categories of 61-100 years. Overweight and Obesity were higher in age categories of 41-60 years. However, underweight was higher in 15-40 years age group.

Table 39: Association between age categories and BMI

BMI Classification p-value

Under-weight (%)

Normal weight (%)

Overweight and Obesity (%)

Total (%)

0.0001

Age categories 15-40 75 (9.23) 554 (68.14) 184 (22.63) 813 (100)

41-60 45 (8.46) 315 (59.21) 172 (32.33) 532 (100)

61-100 38 (25.17) 85 (56.29) 28 (18.54) 151 (100)

Total 158 (10.56) 954 (63.77) 384 (25.67) 1496 (100)

Out of 1,441 participants in body mass index variables, 154 were underweight, 915 had normal weight and 360 were in overweight and obesity categories. Possible asthma like symptoms was found 12.34 percent in underweight participants, 1.53 percent were in participants of normal weight categories and 3.23 percent were in overweight participants.


Table 40: Association between BMI with Possible asthma like symptoms

Possible asthma like symptomsp-value

Yes (%) No (%) Total (%)BMI Classification Underweight 19 (12.34) 135 (87.66) 154 (100)

0.0001

Normal weight 14 (1.53) 901 (98.47) 915 (100)

Overweight and Obesity 12 (3.23) 360 (96.77) 372 (100)

Total 45 (3.12) 1396 (96.88) 1441 (100)

3.3.2 Relationship of cough related respiratory disease symptoms with indoor environmental factors, smoking habit and age of participants

Usual cough was found in 8 percent of 15-40 age groups, 9.94 percent in 41-60 age groups and 12.42 percent in 61-100 age groups.

Table 41: Association between usual cough and age categories

Usual Coughp-value

Year Yes (%) No (%) Total (%)Age categories 15-40 67 (8.00) 770 (92.00) 837 (100)

0.1

41-60 54 (9.94) 489 (90.06) 543 (100)

61-100 19 (12.42) 134 (87.58) 153 (100)

Total 140 (9.13) 1393 (90.87) 1533 (100)

Around 12.36 percent reported of having usual cough were smokers and 8.19 percent who had cough were non-smokers.

Table 42: Association between usual cough and smoking habit

Usual cough p-value

Yes (%) No (%) Total (%)

0.01

Smoking habit Yes 43 (12.36) 305 (87.64) 348(100)

None 97 (8.19) 1088 (91.81) 1185 (100)

Total 140 (9.13) 1393 (90.87) 1533 (100)

Among 156 adult participants with chimney stoves, usual cough was present in 6.41% and 9.44% among 1377 adults those without chimney.


Table 43: Association between usual cough and pipe joining to stove

Cough usually p-value Yes (%) No (%) Total (%)

0.213Pipe joins to stove/chimney stove

Yes 10 (6.41) 146 (93.59) 156 (100)No 130 (9.44) 1247 (90.56) 1377 (100)

Total 140 (9.13) 1393 (90.87) 1533 (100)

Similarly,3.23 percent participants who reported usual cough had chimney stoves whereas only 5.25 percent out of 1353 participants among those who did not have chimney stove.

Table 44: Association between cough every day with pipe join to the stove

Cough every day p-value


0.541

Pipe joining to stove/chimney stoveYes 5 (3.23) 150 (96.77) 155 (100)

No 71 (5.25) 1282 (71.00) 1353 (100)

Total 76 (5.04) 1432 (94.96) 1508 (100)

Usual cough like symptoms were found in7.52 percent participants among those who were exposed to indoor air pollution for 0-2 hours. Similarly, usual like symptoms were found in6.59 percent among those exposed for 3-4 hours to indoor air pollution and 10.23 percent among those who exposed to above 5 hours. However, no association was found between usual Cough and personal exposure to indoor air pollution.

Table 45: Association between usually cough and personal exposure to indoor air pollution

Usually Cough p-valueHour/Day Yes (%) No (%) Total (%)

0.3

Exposure

0-2 10 (7.52) 123 (92.48) 133 (100)

3-4 11 (6.59) 156 (93.41) 167 (100)

5+ 36 (10.23) 316 (89.77) 352 (100)

Total 57 (9.13) 595 (90.87) 652 (100)

Out of 155 participants whose house has stove pipe joining for emitting indoor air pollution from kitchen, coughing everyday for more than three months was found in 2.58 percent. No significant association was found between cough every day for more than 3 months with pipe join to stove.


Table 46: Association between cough every day for more than 3 months with pipe join to stove

Coughing everyday for more than 3 months

p-value


0.802Pipe joins to the stove/chimney stove

Yes 4 (2.58) 151 (97.42) 155 (100)

No 50 (3.70) 1303 (96.30) 1353 (100)

Total 54 (3.58) 1454 (96.42) 1508 (100)

3.3.3Relationship of possible asthma like symptoms with indoor environmental factors,age and smoking habit participants

The table shows the distributions of possible asthma like symptoms in given age groups. Out of 1,476 adult participants, 3.12 percent reported possible asthma like symptoms. Out of 148 participants belonging to 61-100 age groups, 19.59 percent reported the possible asthma likes symptoms. Statistical significance was found in terms of the distribution of possible asthma like symptom in different age group.

Table 47: Association between possible asthma like symptoms with age

Possible asthma like symptoms P-value


0.0001Age categories

15-40 7 (0.87) 795 (99.13) 802 (100)

41-60 10 (1.90) 516 (98.10) 526 (100)

61-100 29 (19.59) 119 (80.41) 148 (100)

Total 46 (3.12) 1430 (96.88) 1476 (100)

Out of 1,476 participants, 154 were from household having pipe joining to stove, and 1322 participants were from households with not having pipe joining to the stove. Possible asthma like symptoms was revealed in 3.25% having pipe joining to the stove and it was in 3.10%, who did not have pipe joining to the stove.

Table 48: Association between possible asthma like symptoms with pipe joints to the stove

Possible asthma like symptomsp-value


Pipe joining stove/ chimney stoveYes 5 (3.25) 149 (96.75) 154 (100)

0.922No 41 (3.10) 1281 (96.90) 1322 100)

Total 46 (3.12) 1430 (96.88) 1476 (100)


Out of 632 participants, 3.48 percent developed possible asthma like symptoms. Out of339 participants who were exposed for 5+ hours to indoor air pollution, 3.83 percent developed asthma like symptoms. However, no significant association was found between possible asthma like symptoms and personal exposure to indoor air pollution.

Table 49:Association between possible asthma like symptoms and personal exposure to indoor air pollution

Possible asthma like symptoms p- value

Exposure

Hour/Day Yes (%) No (%) Total (%)

0.383

0-2 2 (1.54) 128 (98.46) 130 (100)

3-4 7 (4.29) 156 (95.71) 163 (100)

5+ 13 (3.83) 326 (96.17) 339 (100)

Total 22 (3.48) 610 (96.52) 632 (100)

Out of 1,476 participants, more than 97 percent were using unclean fuel for cooking. Possible asthma like symptoms was seen in 3.18 percent participants who were using unclean fuel. Furthermore, possible asthma like symptoms was not seen in clean fuel user. No significant association was found between possible asthma like symptoms with fuel type.

Table 50: Association between possible asthma like symptoms with fuel type

Possible asthma like symptoms p-value


0.29*Fuel typeUnclean 46 (3.18) 1101 (96.82) 1447 (100.00)

Clean 0 (0.00) 29 (100.00) 29 (100.00)

Total 46 (3.12) 1430 (96.88) 1476 (100.00)


Out of 291 clean stove user participants, 3.78% reported possible asthma like symptoms whereas 3.78% out of 1,178 unclean stove user participants reported possible asthma like symptoms.

Table 51: Association between possible asthma like symptoms with stove type

Possible asthma like symptoms p-valueYes (%) No (%) Total (%) 0.79

Stove typeUnclean 35 (2.95) 1150 (97.05) 1185 (100)

Clean 11 (3.78) 280 (96.22) 291 (100)

Total 46 (3.12) 1430 (96.88) 1476 (100)


3.3.4Relationship of indoor air pollutants and smoking habit of participants with Pulmonary Function Test

Among those who were exposed for 0-2 hours to indoor air pollution, FEV1/FVC ratio measured was <0.80 with 12.71 percent participants. The participants among those who exposed to 3-4 hours to indoor air pollution, FEV1/FVC ratio<0.80 was in 11.18 percent and participants among those who exposed to 5+ hours, the FEV1/FVC ratio (<0.80) was in 19.79 percent.Pulmonary/Lung function test (FEV1/FVC ratio) of participants was varied as per level of exposure to indoor air. Pulmonary function test was found to be statistically significant with exposure duration.

Table 52: Association between Pulmonary function test with exposure duration

Pulmonary Function Test (FEV1/FVC ratio) p-value

Hour/Day ≤0.80 >0.80 Total (%)

0.03Exposure

0-2 15(12.71) 103(87.29) 118(100)

3-4 17 (11.18) 135 (88.82) 152 (100)

5+ 57 (19.79) 231 (80.21) 288 (100)

Total 89 (15.95) 469 (84.05) 558 (100)

Out of 1,285 participants, 284 were current smoker and 1,001 participants were none smoker. Pulmonary Function Test FEV1/FVC ratio (<0.80) was in 23.24 percent among current smoker and it was 16.58 percent among nonsmoker. Pulmonary function test of current smoker and nonsmoker was found to be statistically significant between lung function tests.

Table 53: Association between Pulmonary Function Test with a smoking habit

Pulmonary Function Test (FEV1/FVC ratio) p- value≤0.80 >0.80 Total (%)

0.01Current SmokerYes 66(23.24) 218 (76.76) 284 (100)

None 166 (16.58) 835 (83.42) 1001 (100)

Total 232 (18.05) 1053 (81.95) 1285 (100)

Out of 151 participants, 10.60 percent past smoker's Pulmonary Function Test (FEV1/FVC ratio was measured to be <0.80. A significant association was found between Pulmonary Function Test (FEV1/FVC ratio <0.80) and past smoking habit.

Table 54:Association between Pulmonary Function Tests with past smoking habit

Pulmonary Function Test (FEV1/FVC ratio) p- valuePast smoker ≤0.80 >0.80 Total (%)

0.01Past smokerNo 216 (19.05) 918 (80.95) 1134 (100)Yes 16 (10.60) 135 (89.40) 151 (100)

Total 232 (18.05) 1053 (81.95) 1285 (100)


Out of 1285 participants, fuel wood user were 741, Mixed fuel user was519, and clean fuel user were 9.Pulmonary Function Test (FEV1/FVC ratio ≤0.80) was 18.89 percent in fuel wood user, 15.99 percent in mixed fuel user and 36.00 percent in clean fuel user. However, out of total FEV1/FVC ratio ≤0.80, who use various types of fuel used for cooking, FEV1/FVC ratio ≤0.80 in fuel wood users were nearly 60 percent, and 36 percent in mixed fuel users and only 4 percent were in clean users.

Table 55: Association between Pulmonary Function Test with Fuel type

Pulmonary Function Test (FEV1FVC ratio) p-value

≤0.80 >0.80 Total (%)

0.02Fuel types

Wood 140 (18.89) 601 (81.11) 741 (100)

Mixed 83 (15.99) 436 (84.01) 519 (100)

Clean 9 (36.00) 16 (64.00) 25 (100)

Total 232 (18.05) 1053(81.95) 1285 (100)

Out of 1,285 participants, 628 were from traditional stove, 388 were mixed fuel user, and 269 were clean fuel user. Pulmonary Function Test (FEV1/FVC ratio ≤0.80) was 17.11percentin traditional stove user, 14.91 percent in mixed type of stove user and 25.10 percent in clean stove user. However, out of total FEV1/FVC ratio ≤0.80, who use various types of stove for cooking, FEV1/FVC ratio ≤0.80 traditional stove users were 47 percent, and mixed fuel users were 25 percent and clean users were 28 percent.

Table 56: Association between Pulmonary Function Test with stove type

Pulmonary Function Test (FEV1/FVC ratio) p-value

≤0.80 >0.80 Total (%)

0.003Types of stove

Traditional Stove 109 (17.11) 528 (82.89) 637 (100)

Mixed Stove 58 (14.91) 331 (85.09) 389 (100)

Clean Stove 65 (25.10) 194 (74.90) 259 (100)

Total 232 (18.05) 1053 (81.95) 1285 (100)

3.3.5Relationship of hypertension with indoor environmental factors and smoking habit of participants

Blood pressure assessment was done among 1,529 participants. Hypertension were in 18.23 percent among 834 participants of age (15-40) group. In addition, it was found in 39.78 percent participants of age (41-60) group. Similarly, hypertension was found in 46.05 percent of age group above 60. Hypertension was found in increasing order as age is increasing.It is found statistically significant.


Table 57: Association between age of participants with Hypertension

Hypertensionp-value

Year Yes (%) No (%) Total (%)

Age categories

15-40 152 (18.23) 682 (81.77) 834 (100.00)

0.00041-60 216 (39.78) 327 (60.22) 543 (100.00)

61-100 70 (46.05) 82 (53.95) 152 (100.00)

Total 438 (28.65) 1091 (71.35) 1529 (100.00)

Out of 1,529 participants in hypertension assessment, 1500 were unclean fuel user and 29 were clean fuel user. Hypertension was found 28.60% in unclean (traditional and mixed) stove user and 31.03% in clean stove user. However, out of total hypertension, who use various types of stove for cooking, hypertension in unclean stove users were 98%, and clean users were 2%.

Table 58: Association between hypertension with use of fuel type

Hypertension p-value


0.7Fuel typeUnclean 429 (28.60) 1071 (71.34) 1500 (100.00)

Clean 9 (31.03) 20 (31.03) 29 (100.00)

Total 438 (28.65) 1091 (71.35) 1529 (100.00)

Smoking habit was found to be one of the major indicators of hypertension among study participants. It has also been statistically proved (refer Table 65). The Study shows that slightly more than two-fifth (42.5%) participants who currently smoke reported hypertension. However, about one-fourth participants (24.5%) who are currently non-smokers have also reported hypertension.

Table 59: Association between hypertension with smoking habit



0.001Current SmokerYes 148 (42.53) 200 (57.47) 348 (100)

None 290 (24.56) 891 (75.44) 1181 (100)

Total 438 (28.65) 1091 (71.35) 1529 (100)

Hypertension was seen to be common among participants who were exposed to indoor air pollution in different hours. One-fifth (20%) of the participants who were exposed for 0-2 hours to indoor air


pollution reported hypertension. Similarly, about one-third of the participants who were exposed for 3 hours or more in indoor pollution also reported of hypertension. However, hypertension with duration of exposure in indoor pollution was not found to be statistically significant.


Hour/Day Yes (%) No (%) Total (%)

0.07Exposure

0-2 27 (20.45) 105 (79.55) 132 (100)

3-4 52 (31.14) 115 (68.86 167 (100)

5+ 105 (30.00) 245 (70.00) 350 (100)

Total 184 (28.35) 465 (71.65) 649 (100)Table 60: Association between hypertension with exposure duration

3.3.6 Relationship of participants more than 40 years reporting breathlessness with indoor environmental factors, age and smoking habit

Participants more than 40 years reporting breathlessness were found in 18.23 percent among 351 participants of age (15-40) group. Furthermore, it was found in 17.79 percent participants of age 41-60 years. Similarly, participants more than 40 years reporting breathlessness was found in 26.61 percent of age 61-100 years. Participants more than 40 years reporting breathlessness was found in increasing order as age of participants is increases. Participants more than 40 years reporting breathlessness is statistically associated with age of participants.

Table 61: Association between participants more than 40 years reporting breathlessness with age of participants

Participants more than 40 years reporting breathlessness p-value

Year Yes (%) No (%) Total (%)

0.000Age categories

15-40 14 (3.99) 337 (96.01) 351 (100)

41-60 50 (17.79) 231 (82.21) 281 (100)

61-100 29 (26.61) 80 (73.39) 109 (100)

Total 93 (12.55) 648 (87.45) 741 (100)

Out of 741 participants of above 40 years, all were unclean (wood and mixed) fuel user. Participants more than 40 years reporting breathlessness was found 16.44 percent who were using fuel wood. Similarly, participants more than 40 years reporting breathlessness was found in 10.51 percent who were used mixed type of fuel, and it was not found in clean fuel user. The significant association is found between participants more than 40 years reporting breathlessness with fuel type.


Table 62: Association between participants more than 40 years reporting breathlessness and fuel type

Participants more than 40 years reporting breathlessness p-valueYes (%) No (%) Total (%)

0.01Fuel type

Wood 48 (16.44) 244 (83.56) 292 (100)

Mixed 45 (10.51) 383 (89.49) 428 (100)

Clean 0 (0.00) 21 (100.00) 21 (100)

Total 93 (12.55) 648 (87.45) 741 (100)

Participants of more than 40 years reporting breathlessness were seen to be common among participants who were exposed to indoor air pollution in different hours. About 7.69 percent of the participants, who were exposed for 0-2 hours to indoor air pollution, reported participants more than 40 years reporting breathlessness. Similarly, it was revealed in 6.8 percent of the participants who were exposed for 3-4 hours and participants more than 40 years reporting breathlessness was found in 17.73 percent, who were exposed for 5 hours or more to indoor air pollution in indoor pollution. Participants more than 40 years reporting related breathlessness are found statistically significant with duration of exposure in indoor pollution.

Table 63: Association between participants of more than 40 years reporting breathlessness and exposure duration

Participants of more than 40 years reporting breathlessness p-valueHour/Day Yes (%) No (%) Total (%)

0.01Exposure0-2 5(7.69) 60(92.31) 65(100)3-4 7(6.80) 96(93.20) 103(100)5+ 25(17.73) 116(82.27) 141(100)

Total 37(11.97) 272(88.03) 309(100)

Out of 741 participants, 216 were smoker and 525 were nonsmoker. Around 17.59 percent of smokers from participants more than 40 years were found reporting breathlessness and participants more than 40 years reporting breathlessness were found in10.48 percent non-smoker participants more than 40 years reporting breathlessness is found associated statistically significantly with smoking habit of participants.

Table 64: Association between participants more than 40 years reporting breathlessness and smoking habit

Participants more than 40 years reporting breathlessness p-valueYes (%) No (%) Total (%) 0.008

Smoking habit Yes 38 (17.59) 178 (82.41) 216 (100)None 55 (10.48) 470 (89.52) 525 (100)

Total 93(12.55)

648(87.45)

741(100)


CHAPTER

DISCUSSION

4

Indoor air pollution is still a major problem in LMICs[2].Biomass fuelremains the primary sources of household energy in most of the LMICS. Poorly functioning traditional stove and inadequate ventilation in kitchen and living room are additional causes of deteriorating indoor air quality[11, 15]. In most rural part of Nepal, women and children are highly vulnerable to indoor smoke, the exposure duration seems to be relatively higher compared to male[11, 16]. This is the first community based cross-sectional study about respiratory health effect of indoor pollution in Ilam district. Majority of the households and kitchens used dearth/sand, plam/bamboo, cardboard, and galvanized sheets as raw materials for building shelter. The findings are similar to national household and kitchen characteristics[17].The average door size was smaller than the recommended size of minimum opening of doorways 1.4 m2[10]. Household cooking system plays a significant role in disease prevalence[11, 18]. As per the current study findings, more than fifty percent population of the district werestill dependent on traditional stoves (open hearth), which was over two times higher than clean stove user. However, the district has progressed in ICS with respect to national coverage [17]. Similarly, it was found that around ninety seven percent of household population depends on wood and mixed type of fuel for cooking. However, the fuel wood users and clean fuel users are less than the national value of hilly districts[17]. Further, mixed type of fuel users for cooking system was prevalent. Household sanitation and water treatment practice is also important for reducing the disease burden in community level. Almost all household have established the sanitation facilities, therefore sanitation coverage area is higher with respect to national sanitation coverage of Nepal[7, 17]. Pit latrine with slab, toilet flush to septic tank, flush to piped sewer system, ventilated improved pit latrine and pit latrine without slab/open pit were common toilet facilities used in the households. And almost all households had used boiling as a purification method for drinking water. This indicates that household drinking water purification practice is better in this district with respect to country situation[17].

Respiratory infection and acute respiratory infection among children ≤ age 5 years was found higher with respect to age group 6-14 years, though it was not found statistically significant. The national prevalence of acute respiratory infection among children ≤ age 5 year is more than two percent and less than eight percent. It is higherat lower age group of children≤ age 5 year[19].According to a previous study, episodes of acute respiratory infection were also found higher in infant and children


under ≤ age group 5[16].

Asthma like symptoms and possible bronchitis were found higher in the age group 6-14 years with respect to ≤ age group 5 and it is found statistically significant. The prevalence of bronchitis was also higher in the age group 6-14 years with respect to children ≤ age 5 years. The finding is also similar to a previous study conducted in rural part of the country [11,16,18]. Respiratory disease infection like recent acute respiratory infection, possible bronchitis and wheezing symptoms among children were found higher in lower ethnic caste with compare to other ethnic groups. Although it is not found statistically significant, possible pneumonia was seemed to be higher in lower caste whichis found statically significant. Various types of respiratory infection were found significantly higher in lower ethnic caste with respect to upper ethnic castes in other studies [16, 20].

Assessed indoor air pollution parameters were found to be the seen the contributing factors on disease burden. Recent respiratory infection, recent ARI, recurrent ARI, wheezing symptoms and asthma like symptoms in the participant living in home with attachment of black smoke on wall of kitchen were found to have higher prevalence compared to the participants with no attachment of black smoke on wall of kitchen. Though, association was not found statistically significant with recent respiratory infection, recent ARI, wheezing symptoms and asthma like symptoms. But disease presence of recurrent ARI is found statistically associated to attachment of black smoke on wall of kitchen. Similar findings were also revealed in other studies from mountain and Hill district[11, 19]. There was important intervention, where fan and pipe were used in stove for emitting indoor air pollution outside kitchen. Recent Infection and possible Bronchitis prevalence were lower in household where fan were used for intervention of indoor air pollution. However, it is not found statistically significant. The studies from different rural parts of the country also shows that respiratory diseases including cardio-vascular disease and low birth weight were found significantly higher in having household where there is no established clean technology[13, 20]. Similarly, unclean stove users found to develop recent ARI and wheezing symptoms higher in percentage when compared to clean fuel users. However it not statistically significant. But, some previous studies also show that there is significant deference between disease prevalence in traditional stove users and clean stove users[4, 16].The prevalence of recent infection, recurrent ARI symptoms, possible Bronchitis, recent ARI, possible pneumonia were found more in unclean fuel users with respect to clean fuel users which is not found statistically significant. Prevalence of bronchitis, pneumonia, Acute Respiratory Infection among population were significantly associated with indoor air pollution parameters (types of ventilation, particulate matter concentration in kitchen, opening of window and door and period of exposure to indoor air pollution)[16, 18].

Health effects of indoor air pollution were separately analyzed age wise (≥ 15 year). Cough, asthma like symptoms, chronic obstructive pulmonary diseases, lung function test and hypertension were dependent variables of indoor air pollution. Usual cough was higher in participants who had not used pipes in stoves for emitting pollution outside the kitchen when compared to households having this technology but the association is not statistically significant. Similarly, usual cough were seen more in unclean stoves and unclean fuel users with respect to clean fuel users and stoves in this study.


Usual cough like respiratory symptoms are also significantly associated to indoor air quality of rural household[20, 21]. In llam district, the prevalence of asthma was seemed to be higher in unclean fuel users than clean fuel users. Although, the association of this indoor air pollution to Asthma like symptoms is not found statistically significant. Similarly, the prevalence of asthma like symptoms were higher among high exposure duration to indoor air pollution. However, it is also not found statistically significant. In contrast, previous studies have shown, there is significant association of indoor air quality and respiratory health effect e.g. bronchial asthma[16, 22].

Lung function capacity of research participants was found to decrease as per the level of exposure to indoor air pollution. The association between indoor exposure and disease prevalence is found statistically significant. Lung function capacity of current smokers had reduced about 1.52 times as compared to non-smokers. Airflow obstruction is found significantly higher in smokers while its effect is insignificant in nonsmokers[20].Further, another study also shows that there is significantly lower lung function in both smokers and non-smokers among rural biomass smoke –exposed dwellers compared to non-biomass exposure[23].There is also significant association between Lung Function (FEV1/FVC ratio <0.80) among past smokers and non-exposure. Out of total participants, whose Lung function capacity is ≤0.80, the prevalence was higher in fuel wood users and in mixed fuel users with respect to clean fuel users. Similarly, the percentage prevalence was lower in clean stove users with respect to traditional and mixed stove users in the participants whose lung function capacity is ≤0.80. Another study conducted in rural parts also shows that airflow obstruction was twice as common among biomass users compared with liquefied petroleum gas users (p <0.001)[6, 20, 22].

Hypertension is the leading risk factor for morbidity and mortality worldwide. Various studies show that there is significant association of hypertension with the long term exposure to indoor air pollution and polluted indoor air [24]. The percentage prevalence of hypertension among unclean fuel uses were found to be higher compared to clean fuel users and it is also more among participants who were exposed to indoor air pollution for long duration of time. However, they are not statistically significant. Similarly, hypertension among smokers was also higher among smokers compared to nonsmokers.

Morbidity and mortality of COPD is higher in developing country[25]. COPD is a major killer disease around world including developing and developed country. However its burden is higher in developing parts with compared to developed nation[16, 25]. The percentage prevalence of Participants more than 40 years reporting breathlessness among unclean fuel uses was found to be higher compared to clean fuel users. The association is found statistically significant. Furthermore, participants more than 40 years reportingbreathlessness washigher among participants who were exposed to indoor air pollution for long duration of time, which is also found significantly associated. In addition,participants more than 40 years reporting breathlessness is also found significant increases among smokers with compared to nonsmokers.


CHAPTER

CONCLUSION AND RECOMMENDATION

5

5.1 Conclusion

The study was carried out by observing household characteristics, monitoring of indoor air pollution (PM2.5), personal indoor air pollution exposure and health conditions of local people of Ilam District. It has been concluded that the findings were highly relevant for following aspects.

1. Door and window size of kitchen has found below the recommended size of the minimum opening of doorways 1.4 m2. .

2. Energy utilization practice and stove types playing a significant role for emitting indoor air pollution. Burning of fuel wood and mixed fuel for cooking and lighting, and using of traditional stove and mixed type of stoves are found major source of indoor air pollution. Disease prevalence is relatively more in unclean fuel and traditional stove user, but it is not statistically significant.

3. Smoking habit of a person and exposure to the smoke affects the health of the people

4. Hypertension is associated to indoor smoke exposure level and smoking habit of a person.

5. Lung function of the adult is associated with exposure level and smoking habits.

6. Respiratory Infection and respiratory disease symptoms among children, such as recurrent ARI symptoms among children under 15 years age has associated with attachment of black smog on wall of kitchen.

7. Possible Bronchitis among children under 15 years age is associated with fan attached to the stove for emitting pollution outside the kitchen.

5.2Recommendations

The following recommendations are suggested on the basis of current study findings.

1. People should be to build houses and kitchen with proper ventilation. The houses should meet the standard suggested by the Government of Nepal.

2. Government should promote alternative technology such as ICS and clean fuel to rural people and people should adopt this technology in their household so that respiratory disease burden can be reduced.


REFERENCES

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2. Bruce, N., R. Perez-Padilla, and R. Albalak, Indoor air pollution in developing countries: a major environmental and public health challenge. Bull World Health Organ, 2000. 78(9): p. 1078-92.

3. West, S.K., et al., Is household air pollution a risk factor for eye disease? Int J Environ Res Public Health, 2013. 10(11): p. 5378-98.

4. Po, J.Y., J.M. FitzGerald, and C. Carlsten, Respiratory disease associated with solid biomass fuel exposure in rural women and children: systematic review and meta-analysis. Thorax, 2011. 66(3): p. 232-9.

5. Gordon, S.B., et al., Respiratory risks from household air pollution in low and middle income countries. Lancet Respir Med, 2014. 2(10): p. 823-860.

6. Kurmi, O.P., et al., Tuberculosis risk from exposure to solid fuel smoke: a systematic review and meta-analysis. J Epidemiol Community Health, 2014. 68(12): p. 1112-8.

7. CBS, National Population and Housing Census 2011. 2012, Central Bureau of Statistics, National Planning Commission Secretariat,Goverment of Nepal: Kathmandu. p. 278.

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12. Joshi, H., R. Pandeya, and B. Dhakal, Health impact of indoor pollution. J Nepal Health Res Counc, 2009 Oct. 7((15)): p. 69-75.

13. Reid, H., K.R. Smith, and BJ.Sherchand, Indoor smoke exposures from traditional and improved woodstoves: comparisons among rural Nepali women. Mountain Res Dev 1986. 6 p. 293 - 304.

14. GoN, C., "National Population and Housing Census 2011(National Report)" (PDF) 2012, Central Bureau of Statistics (CBS); Government of Nepal (GoN). Kathamandu, Nepal.

15. Pokhrel, A.K., et al., Case-control study of indoor cooking smoke exposure and cataract in Nepal and India. Int. J. Epidemiol, 2005. 34(702-708).

16. Joshi, H.D., R. Pandeya, and B. Dhakal, Health Impact of Indoor Air Pollution. J Nepal Health Res Counc, 2009 Apr. 7(2 ): p. 69-75.

17. CBS. Environment Statistics of Nepal 2013. 2013 [cited 2017; Available from: http://cbs.gov.np/sectoral_statistics/Environment/esn2013.

18. Dhimal, M., et al., Environmental Burden of Acute Respiratory Infection and Pneumonia due to Indoor Smoke in


Dhading. J Nepal Health Res Counc, 2010 Apr. 8(16): p. 1-4.

19. MoH, USAID, and N. ERA, Demographic and Health Survey 2011. ;2012, Ministry of Health, New ERA and USAID: Kathmandu, Nepal.

20. Kurmi, O., et al., Reduced lung function due to biomass smoke exposure in young adults in rural Nepal. Eur Respir J, 2013. 41: p. 25-30.

21. Gurung, A. and M.L. Bell, The state of scientific evidence on air pollution and human health in Nepal. Environmental Research, 2013. 124: p. 54-64.

22. Pandey, M.R., Domestic smoke pollution and chronic bronchitis in a rural community of the hill region of Nepal. Thorax, 1984b. 39: p. 337-339.

23. Shrestha, I.L. and S.L. Shrestha, Indoor air pollution from biomass fuels and respiratory health of the exposed population in Nepalese household. Int J Occup Environ Health, 2005. 11: p. 150-160.

24. Baumgartner, J., et al., Indoor Air Pollution and Blood Pressure in Adult Women Living in Rural China. Environ Health Perspect, 2011. 119: p. 390-1395.

25. Kurmi, O., et al., COPD and chronic bronchitis risk of indoor air pollution from solid fuel: a systematic review and meta-analysis Thorax 2010. 65: p. 221-228.


ANNEXES1. Selected VDC and Ward

Cluster ID VDC Ward NO No of HHs Sample size

1 Bajho 9 633 30

2 Chisapani 1 135 30

3 Chulachuli 5 495 30

4 Danabari 4 365 30

5 Ektappa 7 113 30

6 Ibhang 1 206 30

7 Ilam Municipality 4 346 30

8 Irautar 8 168 30

9 Jitpur 8 179 30

10 Kolbung 6 87 30

11 Mabu 4 82 30

12 Maipokhari 9 164 30

13 Nayabazar 4 266 30

14 Panchakanya 7 247 30

15 Phakphok 4 84 30

16 Phikkal 9 144 30

17 Sakhejung 5 157 30

18 Shantidanda 3 144 30

19 Siddhithumka 4 122 30

20 Sumbek 2 90 30

Total 4,227 600


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slxn} b]vf k/]g ===============================xKtfdf @ jf ;f] eGbf sd===============xKtfdf @ k6s eGbf al9 t/ lbgdf ! k6s eGbf sd============b}gLs==============================

nuftf/ nIf0f b]lvof] ==========================

!

@

#

$

%

%# laut !@ dlxgfdf :jf; km]g{ ufX/f] eP/ cyjfvf]sLsf]

sf/0fn] /ftsf] ;dodfslt k6s ljplemg' eof] <

slxn} ljplemgdlxgfdf ! k6s jf ;f] eGbfsdxKtfdf !jf @ k6s xKtfdf # k6s jf ;f] eGbf al9

!@#$

%$ s] tkfO{nfO{ slxNn} 8fS6/ jf g;{n] bdsf] cf}iflw vfg eg]sf lyP<

lyof] lyPg

!

@

%% To:tf ]cf}iflwsf] k|of]u kZrft :of :of x'g] ;d:ofdf cfPsf] ;'wf/nfO{ s;l/ d'Nofsgug'{ x'G5 <

pNn]Vo yf]/} lgs} sd

!@#

cGo /f]ux?sf] ljifodf

%^ s] tkfO{nfO{ ljutdf nfdf]vf]sL nfu]/ vsf/df /ut b]vf k/]sf] lyof] <

lyof] lyPg

!@ %(

%& s] ;f] ;d:of ;+u} /ftsf] ;dodf cToflws kl;gf cfpg], Hj/f] cfpg] tyf tf}n 36\g] ;d:ofx? klg b]vf k/]<

k¥of] k/]g

!

@

%* To:tf] x'Fbf :jf:Yo ;:yfdf uP/ vsf/ kl/If0f u/fpg' eof] <

u/] ul/g

!

@

%( s] tkfO{df slxNo}Ifo/f]u b]vf k/]sf] lyof] < lyof] lyPg

!

@ ^#

^) s] :jf:Yo sfo{stf{x?n] tkfO{sf] vsf/df Ifo/f]usf lhaf0f'x? b]vf k/]sf] 5 elg eg]sf lyP <

lyof] lyPg

!

@

^! s] tkfOnfO{ :jf:Yo sfo{stf{x?n] Ifo/f]usf] cf}iflw lbPsf lyP <

lyof] lyPg

!

@

^@ olb lYfof] eg] ;f] cf}iflw slt ;do ;Dd ;]jgug'{ eof] < ============ dlxgf


^# s] lgDglnlvt :jf:Yo ;d:ofx? slxNo} ePsf lyP<

5ftLsf] zNolqmofd'6'df ;d:ofpRr /Qmrfk

lyof] ! lyPg @ ! @! @

! @

Reading of Spirometry

64. Weight _______(Kg)

65. Height ________(cm)

66. Pulse _____ per min

67. BP _____________

68. Temperature _________

69. Respiration Rate ___________

70. Pallor a) Yes b) No

71. Cyanosis a) Yes b) No

72. Oxygen saturation ( Use the pulse oximeter provided to you and record the highest reading of SpO2 and lowest reading of heart rate after 3 recordings) HR: SpO2:

73. Did the person perform spirometry? Yes No

74. If no, why was spirometry not done?

a. Recent operation Recent MI Recent Stroke MDR TB Did not consent Could not perform

75. Spirometry ID

76. Best spirometry reading:

a. Pre: FVC FEV1 FEV1/FVC PEFR

b. Post: FVC FEV1 FEV1/FVC PEFR

3. Child Questionnaire Tool3/leqsf] k|b'if0faf6 dfgj :jf:Yo df kfg]{ k|efjx?sf] cWoog k|ZgfjnL

-!% jif{eGbf sd pd]/sf afnaflnsfx?sf] nflu_

JolQut ljj/0f

k|Zgx? hjfkmx? sf]8

! g= kf=÷uf =lj= ; -sf]8_

@ jf8{ g+{M

# Sn:6/ g+=


$ 3/sf] klxrfg g+=

% cGt/jftf{sf] ldlt

lbg dlxgf jif{

^ pQ/bftfsf] gfd ========================.

& pQ/bftfsf] y/ ===========================

* lnË k'?ifdlxnf

!@

( tkfO{sf] hGd ldlt eGg'xf];\ .

lbg dlxgf jif{

!) k"/f ePsf] pd]/ jif{

% jif{ eGbf sd pd]/sf aRrfx?sf] kf]if0f ;DalGw k||Zgx? -aRrfsf] cfdfnfO{ ;f]Wg] _

!! ue{j:yfsf] slt ;dodf aRrfsf] hGd ePsf] lyof] <

( dlxgf k'/f eP/* b]lv ( dlxgfdf& b]lv * dlxgfdf& dlxgf eGbf sd

!@#$

!@ s] gjhft lzz'df s'g} :jf:Yo ;d:of blvPsf] lyof] <

lyof]

lyPg

!

@

!# tkfO{sf] aRrf hGdbfv]l/sf] tf}nslt lyof] < =====================u|fdyfxf 5}g

!$ s] tkfO{n] cfˆgf] aRrf nfO{ la3f}tL b'w v'jfpg' eof] <

v'jfP v'jfOg

!@

!% tkfO{n] cfˆgf] aRrf nfO{ cfdf sf] b'w dfq stL dlxgf ;Dd v'jfpg' eof] <

dlxgf ;Dd

!^ s] tkfO{n] cfˆgf] aRrfnfO ;a} vf]kx? lbnfpg' ePsf] lyof] <

lyof] lyPg

!@

% jif{ eGbf a9L pd]/sf s]6f s]l6 jf aRrfx? ;+u ;DalGwt k|Zgx?aRrf pQ/ lbg ;Sg] cj:yfdf eP aRrfnfO{ / aRrf pQ/ lbg g;Sg] cj:yfdf eP cfdfnfO{ ;f]Wg]

!& tkfO{n] ;du|df cf}krfl/s lzIffsf nfuL slt jif{ latfpg'eof] < -k"j{ k|fylds tx nfO{ ;dfj]z gug]{_

jif{

!* tkfO{n] k"/f ug'[{ ePsf] dflyNnf] txsf] lzIff s'g xf]<

cgf}krfl/s lzIffk|fylds eGbf sdk|fylds tx dfWolds txk|lj0ftf jf pRr lzIff

!@#$%


tnsf !( b]lv #) ;Ddsf k|Zgx? % jif{ eGbf sd pd]/sf] aRrfsf] :jf; k|:jf; ;DalGw /f]ux? ;+u ;DalGwt 5g\ . oL k|:gx? aRrfsf] cfdfnfO{ ;f]Wg] tyf cfj:ostf cg';f/ dlxnf :jf:Yo :jod ;]ljsf ;+u /xg] aRrfsf] :jf:Yo ;DalGw tflnsf ;+u bfh]/ x]g]{

k|=g+ k|Zgx¿ hjfkmx¿ sf]8

!( s] tkfO{sf] aRrfnfO{ ljut @ xKtfdf Hj/f] cfPsf] lyof] <

lyof] lyPg

!→!(v @

!( s s] tkfO{sf] aRrfnfO{ ljut $ xKtfdf Hj/f] cfPsf] lyof] <

lyof] lyPg

!→!(v @

!( v s] To;sf] nflu pkrf/ jf ;'emfj lng' ePsf] lyof] <

lyof] lyPg

!

@→@)

!( u pkrf/ sxfF u/fpg' eof] < ;/sf/L c:ktfn k|fylds :jf:Yo s]Gb| :jf:Yo rf}sL pk :jf:Yo rf}sL lghL ;]jf k|bfos

!@#$%

!( 3 aRrfnfO{ s'g} cf}ifwL lbOPsf] lyof] <

lbOPsf] lyof] lbOPsf] lyPg

!@

!( ª olb lbOPsf] lyof] eg] s'g cf}ifwL lbOPsf] lyof] <

Pl06jfof]l6scGo

!@

@) s] tkfO{sf] aRrfnfO{ ljut @ xKtfdf vf]sL nfu]sf] lyof] <

lyof] lyPg

!→@@@

@! s] tkfO{sf] aRrfnfO{ ljut $ xKtfdf vf]sL nfu]sf] lyof] <

lyof] lyPg

!

@→#!

@@ s] vf]sL ;Fu} l56f] l56f] ;f; lng] cyjf ;f; km]g{] cK7\of/f] x'g] dx;'; ePsf] lyof] <

lyof] lyPg

!@

@# s] tkfO{nfO{ cfkmgf] jRrfsf] :jf; k|:jf;df ;d:of gfs aGb ePsf]n] dfq ePsf] xf] eGg] nfu]sf] lyof] <

lyof] lyPg

!@

@$ sf] aRrfsf nflu :jf:Yo pkrf/ cyjf ;Nnfx lng' ePsf] lyof] <

lyof] lyPg

!

@→#!

@% olb lyof] eg] :jf:Yo pkrf/ jf ;Nnfx sxfFaf6 lng'ePsf] lyof] <

;/sf/L c:ktfn k|fylds :jf:Yo s]Gb| :jf:Yo rf}sL pk :jf:Yo rf}sL lghL ;]jf k|bfos

!@#$%


@^ s] pkrf/ jf :jf:Yo ;Nnfx d=:-jf=:j=;] af6 sf] ;Nnfx cg';f/ lnOPsf] lyof] <

lyof] lyPg

!

@→@&

@& s] d=:jf=:j=;] ;Fu aRrfsf] tYofÍ pknAw 5 <

@* olb pknAw 5 eg], d=:jf=:j=;] tflnsfdf aRrfsf] :jf; k|:jf;sf] b/ slt pNn]v ePsf] 5 <

====== k|lt ldg]6

@( aRrfnfO{ s'g} cf}ifwL lbOPsf] lyof] <

lyof]lyPg

!@

#) olb lbOPsf] lyof] eg], s'g cf}ifwL lbOPsf] lyof] <

Pl06jfof]l6s cGo -pNn]v ug'{xf];_

!@

tnsf k|Zgx? !% jif{ eGbf sd pd]/sf] aRrfsf] :jf; k|:jf; ;DalGw /f]ux? ;+u ;DalGwt 5g\aRrf pQ/ lbg ;Sg] cj:yfdf eP aRrfnfO{ / aRrf pQ/ lbg g;Sg] cj:yfdf eP cfdfnfO{ ;f]Wg]

ARI ;+u ;DalGwt k|Zgx?


#! s] tkfO{nfO{ ÷ tkfO{sf] aRrfnfO{ ¿3f;Fu} vf]sL nflu /xG5 <

nflu/xG5 nfUb}g

!@

#@ s] tkfO{nfO{÷tkfO{sf] aRrfnfO{ ?3f gnfu]sf] a]nf klg vf]sL nfUg] ub{5 <

nfU5 nfUb}g

!

@→#%

## ljut !@ dlxgfdf To:tf] slt k6s eof] ;Demg ;Sg'x'G5 <

Ps dlxgfdf Ps k6s jf ;f] eGbf a9L @ dlxgfdf Ps k6s # dlxgfdf Ps k6s ^ dlxgfdf Ps k6s

!

@#$

#$ s] tkfO{ ;Demg ;Sg' x'G5 ljut @ jif{df To:tf] slt k6s eof] <

======= k6s ;Demg ;lSbg ((

#% s] tkfO{nfO{÷tkfO{sf] aRrfnfO{ ¿3fvf]sL ;Fu} vsf/ klg cfpg] u5{ <

cfp5 cfpb}g

!@

(Asthma) bd;+u ;DalGwt k|Zgx?


#^ s] tkfO{nfO{÷tkfO{sf] aRrfnfO{ ljutdf slxNo} 5fltdf bd h:tf] -5ftLdf l;7L ahfP h:tf]/£of/ £of/ eP/ wDsL eP h:tf]_ x'g] ;d:of b]lvPsf] lyof] <

lyof] lyPg

!

@→#(

#& s] tkfO{nfO{÷tkfO{sf] aRrfnfO{ ljut !@ dlxgfdf bd h:tf] -5ftLdf l;7L ahfP h:tf]/£of/ £of/ eP/ wDsL eP h:tf]_ x'g] ;d:of b]lvPsf] lyof] <

lyof] lyPg

!

@→#(

#* olb lyof] eg] ljut !@ dlxgfdf ;f] ;d:of slt k6s b]lvPsf] lyof] <

! b]lv # k6s $ b]lv !@ k6s !@ k6s eGbf a9L

!@#


#( ljut !@ dlxgfdf, cf}iftdf slt k6s 5fltdf £of/ £of/ ePsfn] tkfO{sf]÷tkfO{sf] aRrfdf lgGb|f gkg{] jf lgGb|f ljyf]lng] ;d:of b]lvPsf] lyof] <

To:tf] slxNo} ePg xKtfdf ! jf ;f] eGbf sd /ftdf xKtfdf ! jf ;f] eGbf j9L /ftdf

!@#

$) ljut !@ dlxgfdf To;/L ;f; km]g{ ufx|f] eP/ af]Ng} ufx|f] x'g] / Ps ;f;df Ps b'O{ zAb dfq af]Ng ;Sg] u/L ckm\7\of/f] ePsf] lyof] <

lyof] lyPg

!@

$! s] tkfO{nfO{ jf tkfO{sf] aRrfnfO{ slxn] cf:ydf ePsf] lyof] <

lyof] lyPg

!@

$@ s] ljut !@ dlxgfdf tkfO{nfO{÷tkfO{sf] aRrfnfO{ v]Nbf bf}l8bf 5fltdf £of/ £of/ cfjfh l;6L ah] h:tf] cfjfh cfPsf] lyof] <

lyof] lyPg

!@

$# ljut !@ dlxgfdf, ¿3f gnfu]sf] jf 5ftLdf ;d:ofgePsf]] cj:yfdf klg /ftsf] ;do ;'Vvf vf]sL nfu]sf] lyof]

lyof] lyPg

!

@→$^

$$ o:tf ;d:ofx?n] ubf{, tkfO{÷tkfO{sf] aRrfn] slt k6s :s'n tyf cGo lgoldt sfo{df ;ËnUg x'g kfpg' ePg <

5}gPs b]lv kfFr lbg5 b]lv bz lbgbz eGbf w]/}

!@#$

$% ljut !@ dlxgfdf, tkfO{÷tkfO{sf] aR-rfdf ?3f vf]sL gnfu]sf], cj:yfdf klg xfR5\of} cfpg], gfsaf6 l;Ífg jlu/xg] jf gfs aGb x'g] ;d:of b]lvPsf lyP <

lyof] lyPg

!@

$^ ljut !@ dlxgfdf, gfssf] ;d:of ;Fu}, cfvf lrnfpg] tyf /l;nf] cfvf x'g] /cfvfaf6 kfgL axg] ;d:of b]lvPsf] lyof] <

lyof] lyPg

!@

$& 8fS6/n] slxNo} tkfO{nfO{÷tkfO{sf] aRrfnfO{ bd jf gfssf] Pnlh{ 5 eg]sf lyP <

lyof] lyPg

!@ %!

$* olb lyP eg], sg' pd]/df To;f] eg]sf lyP <

lyof] lyPg

!@

$( s] tkfO{nfO{÷tkfO{sf] aRrfnfO{ slxn} cf:ydfsf] cf}ifwL vfg ;'emfpg' ePsf] lyof] <

lyof] lyPg

!@

%) olb lyof] eg], s] tkfO{n] {÷tkfO{sf] aRrfn] clxn] ;f] cf}ifwL lnO{/xg' ePsf] 5 <

lyof] lyPg

!@

Ifo/f]u;+u ;DalGwt k|Zgx?

%! s] tkfO{df÷tkfO{sf] aRrfdf slxNo} Ifo/f]usf] ;d:of b]lvPsf] lyof] <

lyof] lyPg

!

@→%$


%@ s'g pd]/df Ifo/f]usf] klxrfg ePsf] lyof] <

lyof] lyPg

!@

%# s'g k|sf/sf] Ifo/f]u ePsf] ktf nfu]sf] lyof] <

kmf]S;f] u|GyL cGo

!@#

%$ s] tkfO{nfO{ jf tkfO{sf] aRrfnfO{ pkrf/ u/fpg' eof] <

lyof] lyPg

!@

lautsf cGo :jf:Yo ;d:of ;+u ;DalGwt k|Zgx?

%% ljutdf slxNo} 5fltdf ulDe/ ;d:ofn] ubf{ tkfO{ jf tkfO{sf] aRrfnfO{ c:kt-fn egf{ ug'{ k/]sf] lyof] <

lyPg lyof], ! k6s lyof], @ k6s lyof, # k6s jf ;f] eGbf a9L

!→%&@#$

%^ olb lyof] eg], klxnf] k6s c:ktfn egf{ ubf{ aRrfsf] pd]/ slt lyof] <

=======================

%& s] 8fS6/n] slxNo} tkfO{nfO{÷tkfO{sf] aRrfnfO{ d'6' ;DaGwL /f]u 5 eg]sf lyP <

lyof] lyPg

!@

%* tkfO{ jf tkfO{sf] aRrfsf] v]Ng] b}l8g] IfdtfnfO{ s;/L kl/eflift ug'{ x'G5 <

lgs} ;ls|oc?sf] t'ngfdf rf8f] yfSg]rf8f} yfs]/ >d÷Jofod ug{ jf v]Ngg;Sg]

!@#

%( s] tn pNn]lvt pd]/df aRrfdf sfg b'Vg] tyf sfgaf6 kfgL÷lkk jxg] ;d:of b]lvPsf] lyof] <

hGd b]lv @ jif{ ljrdf @ b]lv % jif{ ljrdf

% jif{ kl5

lyof] ! lyPg @

! @! @! @

^) s] sfg b'Vg] tyf sfgaf6 lkk÷kf-gL axg] ;d:of ;Fu} ;'Ggdf ;d:of lyof]÷5 <

lyof]÷5 lyPg÷5}g

!@

Spirometry Reading

61. Weight _______(Kg)

61. Height ________(cm)

62. Pulse _____ per min

63. BP _____________

64. Temperature _________

65. Respiration Rate ___________

66. Pallor [ ]

67. Cyanosis [ ]


68. Edema

69. Mid arm circumference (Only for children less than 5 years of age) ………………..cm

70. Oxygen saturation ( Use the pulse oximeter provided to you and record the highest reading of SpO2 and lowest reading of heart rate after 3 recordings) HR: SpO2:

71. Did the child perform spirometry? Yes No

72. If no, why was spirometry not done?

b. Recent operation Recent MI Recent Stroke MDR TB Did not consent Could not perform

73. Spirometry ID

74. Best spirometry reading:

a. Pre: FVC FEV1 FEV1/FVC PEFR

b. Post: FVC FEV1 FEV1/FVC PEFR


NEPA

L HE

ALTH RESEARCH CO

UN

CIL

ESTD. 1991

Nepal Health Research Council (NHRC)Ramshah Path, Kathmandu, NepalTel : +977 1 4254220Fax : +977 1 4262469E-mail : [email protected] Website : www.nhrc.org.np

Government of Nepal


Indoor Air Pollution andits Effects on Human Health inIlam, Nepal2016

Documents

Indoor Air Pollution and its Effects on Human Health in Ilam, …nhrc.gov.np/.../uploads/2017/06/Indoor-air-pollution.pdf · 2018-03-23 · Indoor Air Pollution and its Effects on