Indoor air pollution in developing countries.

Of the four principal categories of indoor pollution (combustion products, chemicals, radon and biologicals), research in developing countries has focused on combustion-generated pollutants, and principally those from solid-fuel-fired cooking and heating stoves. Such stoves are used in more than half the world's households and have been shown in many locations to produce high indoor concentrations of particulates, carbon monoxide and other combustion-related pollutants. Although the proportion of all such household stoves that are used in poorly ventilated situations is uncertain, the total population exposed to excessive concentrations is potentially high, probably several hundred million. A number of studies were carried out in the 1980s to discover the health effects of such stove exposures. The majority of such studies were done in South Asia in homes burning biomass fuels or in China with coal-burning homes, although a sprinkling of studies examining biomass-burning have been done in Oceania, Latin America and Africa. Of the health effects that might be expected from such exposures, little, if any, work seems to have been done on low birthweight and eye problems, although there are anecdotal accounts making the connection. Decreased lung function has been noted in Nepali women reporting more time spent near the stove as it has for Chinese women using coal stoves as compared to those using gas stoves. Respiratory distress symptoms have been associated with use of smoky fuels in West India, Ladakh and in several Chinese studies among different age groups, some with large population samples. Acute respiratory infection in children, one of the chief causes of infant and childhood mortality, has been associated with Nepali household-smoke exposures. Studies of chronic disease endpoints are difficult because of the need to construct exposure histories over long periods. Nevertheless, chronic obstructive lung disease has been associated with the daily time spent near the stove for Nepali women and found to be elevated among coal-stove users compared to gas-stove users in Shanghai. In contrast to early reports, there seems to be little or no risk of nasopharyngeal cancer from cookstove smoke. Several studies in China, however, have found smoke to be a strong risk factor for lung cancer among non-smoking women. In addition, severe fluorosis has been observed in several parts of China where coal fluoride levels are high.(ABSTRACT TRUNCATED AT 250 WORDS)