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Environmental Health and Preventive Medicine

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Open Access 01-12-2021 | Tuberculosis | Research article

Association between household solid fuel use and tuberculosis: cross-sectional data from the Mongolian National Tuberculosis Prevalence Survey

Authors: Munkhjargal Dorjravdan, Katsuyasu Kouda, Tsolmon Boldoo, Naranzul Dambaa, Tugsdelger Sovd, Chikako Nakama, Toshimasa Nishiyama

Published in: Environmental Health and Preventive Medicine | Issue 1/2021

Abstract

Background

Tuberculosis (TB) and indoor air pollution (IAP) are equally critical public health issues in the developing world. Mongolia is experiencing the double burden of TB and IAP due to solid fuel combustion. However, no study has assessed the relationship between household solid fuel use and TB in Mongolia. The present study aimed to assess the association between household solid fuel use and TB based on data from the Mongolian National Tuberculosis Prevalence Survey (MNTP Survey).

Method

The MNTP Survey was a nationally representative population-based cross-sectional survey targeting households in Mongolia from 2014 to 2015, with the aim of evaluating the prevalence of TB. The survey adopted a multistage cluster sampling design in accordance with the World Health Organization prevalence survey guidelines. Clusters with at least 500 residents were selected by random sampling. A sample size of 98 clusters with 54,100 participants was estimated to be required for the survey, and 41,450 participants were included in the final analysis of the present study. A structured questionnaire was used to collect information on environmental and individual factors related to TB. Physical examination, chest X-ray, and sputum examinations were also performed to diagnose TB.

Results

The use of solid fuels for heating (adjusted odds ratio (aOR): 1.5; 95% confidence interval (CI): 1.1–2.1), male gender (aOR: 2.2; 95% CI: 1.6–3.2), divorced or widowed (aOR: 2.6; 95% CI: 1.7–3.8), daily smoker (aOR: 1.8; 95% CI: 1.3–2.5), contact with an active TB case (aOR: 1.7; 95% CI: 1.2–2.3), being underweight (aOR: 3.7; 95% CI: 2.4–5.7), and previous history of TB (aOR: 4.3; 95% CI: 3.0–6.1) were significantly associated with bacteriologically confirmed TB after adjusting for confounding variables.

Conclusion

The use of solid fuels for heating was significantly associated with active TB in Mongolian adults. Increased public awareness is needed on the use of household solid fuels, a source of IAP.

Tuberculosis GBD. Collaborators. The global burden of tuberculosis: results from the Global Burden of Disease Study 2015. Lancet Infect Dis. 2018;18:261–84.CrossRef

World Health Organization. Tuberculosis. Fact sheets. 2020. Available from: https://www.who.int/en/news-room/fact-sheets/detail/tuberculosis.

World Health Organization. Tuberculosis profile: Mongolia. Estimates of TB and MDR-TB burden are produced by WHO in consultation with countries. Available from: https://treattb.org/wp-content/uploads/2018/10/WHO_HQ_Reports-G2-PROD-EXT-TBCountryProfile-_Mongolia.pdf

Narasimhan P, Wood J, Macintyre CR, Mathai D. Risk factors for tuberculosis. Pulm med. 2013;2013:828939.CrossRefPubMedPubMedCentral

Lin HH, Ezzati M, Murray M. Tobacco smoke, indoor air pollution and tuberculosis: a systematic review and meta-analysis. PLoS Med. 2007;4(1):e20. https://doi.org/10.1371/journal.pmed.0040020.CrossRefPubMedPubMedCentral

Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224–60. https://doi.org/10.1016/S0140-6736(12)61766-8.CrossRefPubMedPubMedCentral

Lee KK, Bing R, Kiang J, Bashir S, Spath N, Stelzle D, et al. Adverse health effects associated with household air pollution: a systematic review, meta-analysis, and burden estimation study. Lancet Glob Health. 2020;8(11):e1427–e34. https://doi.org/10.1016/S2214-109X(20)30343-0.CrossRefPubMedPubMedCentral

National Statistics Office Mongolia. Mongolia has launched the main findings of its 2010 Population and Housing Census. Report of the National Statistics Office Mongolia. 2010

Awe Y, Nygard J, Larssen S, Lee H, Dulal H, Kanakia R. Clean air and healthy lungs: enhancing the World Bank's approach to air quality management. Open Knowledge Repository. 2015; Available from: https://openknowledge.worldbank.org/handle/10986/18025.

10.

Apte K, SJF S. Household air pollution and its effects on health. F1000Res. 2016;5:2593.CrossRef

11.

World Health Organization. WHO guidelines for indoor air quality: household fuel combustion. Free Books & Documents. 2014.

12.

Warburton D, Warburton N, Wigfall C, Chimedsuren O, Lodoisamba D, Lodoysamba S, et al. Impact of seasonal winter air pollution on health across the lifespan in Mongolia and some putative solutions. Ann Am Thorac Soc. 2018;15(Suppl 2):S86–s90. https://doi.org/10.1513/AnnalsATS.201710-758MG.CrossRefPubMedPubMedCentral

13.

Allen RW, Gombojav E, Barkhasragchaa B, Byambaa T, Lkhasuren O, Amram O, et al. An assessment of air pollution and its attributable mortality in Ulaanbaatar. Mongolia. Air Qual Atmos Health. 2013;6(1):137–50. https://doi.org/10.1007/s11869-011-0154-3.CrossRefPubMed

14.

Kurmi OP, Semple S, Simkhada P, Smith WC, Ayres JG. COPD and chronic bronchitis risk of indoor air pollution from solid fuel: a systematic review and meta-analysis. Thorax. 2010;65(3):221–8. https://doi.org/10.1136/thx.2009.124644.CrossRefPubMed

15.

Jackson S, Mathews KH, Pulanic D, Falconer R, Rudan I, Campbell H, et al. Risk factors for severe acute lower respiratory infections in children: a systematic review and meta-analysis. Croat Med J. 2013;54(2):110–21. https://doi.org/10.3325/cmj.2013.54.110.CrossRefPubMedPubMedCentral

16.

Kolappan C, Subramani R. Association between biomass fuel and pulmonary tuberculosis: a nested case-control study. Thorax. 2009;64(8):705–8. https://doi.org/10.1136/thx.2008.109405.CrossRefPubMed

17.

Slama K, Chiang CY, Hinderaker SG, Bruce N, Vedal S, Enarson DA. Indoor solid fuel combustion and tuberculosis: is there an association? Int J Tuberc Lung Dis. 2010;14(1):6–14.PubMed

18.

Lin HH, Suk CW, Lo HL, Huang RY, Enarson DA, Chiang CY. Indoor air pollution from solid fuel and tuberculosis: a systematic review and meta-analysis. Int J Tuberc Lung Dis. 2014;18(5):613–21. https://doi.org/10.5588/ijtld.13.0765.CrossRefPubMed

19.

Sumpter C, Chandramohan D. Systematic review and meta-analysis of the associations between indoor air pollution and tuberculosis. Trop Med Int Health. 2013;18(1):101–8. https://doi.org/10.1111/tmi.12013.CrossRefPubMed

20.

Kurmi OP, Sadhra CS, Ayres JG, Sadhra SS. Tuberculosis risk from exposure to solid fuel smoke: a systematic review and meta-analysis. J Epidemiol Community Health. 2014;68(12):1112–8. https://doi.org/10.1136/jech-2014-204120.CrossRefPubMed

21.

Global burden of disease. GBD profile: Mongolia. Global burden of diseases, injuries, and risk factors study 2010. Available from: http://www.healthdata.org/sites/default/files/files/country_profiles/GBD/ihme_gbd_country_report_mongolia.pdf

22.

Cavanaugh R. Extreme air pollution in Mongolia's overflowing capital. Lancet Respir Med. 2017;5(8):614–5. https://doi.org/10.1016/S2213-2600(17)30258-8.CrossRefPubMed

23.

World Health Organization. Tuberculosis prevalence surveys: a handbook 2011. The Lime Book. Available from: https://www.who.int/tb/advisory_bodies/impact_measurement_taskforce/resources_documents/thelimebook/en/.

24.

Tran VV, Park D, Lee YC. Indoor air pollution, related human diseases, and recent trends in the control and improvement of indoor air quality. Int J Environ Res Public Health. 2020;17(8):2927. https://doi.org/10.3390/ijerph17082927.CrossRefPubMedCentral

25.

Kurmi OP, Lam KB, Ayres JG. Indoor air pollution and the lung in low- and medium-income countries. Eur Respir J. 2012;40(1):239–54. https://doi.org/10.1183/09031936.00190211.CrossRefPubMed

26.

García-Sancho MC, García-García L, Báez-Saldaña R, Ponce-De-León A, Sifuentes-Osornio J, Bobadilla-Del-valle M, et al. Indoor pollution as an occupational risk factor for tuberculosis among women: a population-based, gender oriented, case-control study in Southern Mexico. Rev Invest Clin. 2009;61(5):392–8.PubMed

27.

Pokhrel AK, Bates MN, Verma SC, Joshi HS, Sreeramareddy CT, Smith KR. Tuberculosis and indoor biomass and kerosene use in Nepal: a case-control study. Environ Health Perspect. 2010;118(4):558–64. https://doi.org/10.1289/ehp.0901032.CrossRefPubMed

28.

Obore N, Kawuki J, Guan J, Papabathini SS, Wang L. Association between indoor air pollution, tobacco smoke and tuberculosis: an updated systematic review and meta-analysis. Public health. 2020;187:24–35. https://doi.org/10.1016/j.puhe.2020.07.031.CrossRefPubMed

29.

Barabad MLM, Jung W, Versoza ME, Kim M, Ko S, Park D, et al. Emission characteristics of particulate matter, volatile organic compounds, and trace elements from the combustion of coals in Mongolia. Int J Environ Res Public Health. 2018;15(1706).

30.

Patel V, Foster A, Salem A, Kumar A, Kumar V, Biswas B, et al. Long-term exposure to indoor air pollution and risk of tuberculosis. Indoor Air. 2020;32:628–83.

31.

Sarkar S, Rivas-Santiago CE, Ibironke OA, Carranza C, Meng Q, Osornio-Vargas Á, et al. Season and size of urban particulate matter differentially affect cytotoxicity and human immune responses to Mycobacterium tuberculosis. PloS One. 2019;14(7):e0219122. https://doi.org/10.1371/journal.pone.0219122.CrossRefPubMedPubMedCentral

32.

Rivas-Santiago CE, Sarkar S, Cantarella P, Osornio-Vargas Á, Quintana-Belmares R, Meng Q, et al. Air pollution particulate matter alters antimycobacterial respiratory epithelium innate immunity. Infect Immun. 2015;83(6):2507–17. https://doi.org/10.1128/IAI.03018-14.CrossRefPubMedPubMedCentral

33.

Ezzati M, Kammen DM. The health impacts of exposure to indoor air pollution from solid fuels in developing countries: knowledge, gaps, and data needs. Environ Health Perspect. 2002;110(11):1057–68. https://doi.org/10.1289/ehp.021101057.CrossRefPubMedPubMedCentral

34.

Jassal MS, Bakman I, Jones B. Correlation of ambient pollution level and heavily-trafficked roadway proximity on the prevalence of smear positive tuberculosis. Public Health. 2013;127(3):268–74. https://doi.org/10.1016/j.puhe.2012.12.030.CrossRefPubMed

35.

Chen KY, Chuang KJ, Liu HC, Lee KY, Feng PH, Su CL, et al. Particulate matter is associated with sputum culture conversion in patients with culture-positive tuberculosis. Ther Clin Risk Manag. 2016;12:41–6. https://doi.org/10.2147/TCRM.S92927.CrossRefPubMedPubMedCentral

36.

Hill LD, Edwards R, Turner JR, Argo YD, Olkhanud PB, Odsuren M, et al. Health assessment of future PM _2.5 exposures from indoor, outdoor, and secondhand tobacco smoke concentrations under alternative policy pathways in Ulaanbaatar, Mongolia. PloS One. 2017;12(10):e0186834. https://doi.org/10.1371/journal.pone.0186834.CrossRefPubMedPubMedCentral

37.

Enkh-Undraa D, Kanda S, Shima M, Shimono T, Miyake M, Yoda Y, et al. Coal burning-derived SO ₂ and traffic-derived NO ₂ are associated with persistent cough and current wheezing symptoms among schoolchildren in Ulaanbaatar. Mongolia. Environ Health Prev Med. 2019;24(1):66. https://doi.org/10.1186/s12199-019-0817-5.CrossRefPubMed

38.

Lim M, Myagmarchuluun S, Ban H, Hwang Y, Ochir C, Lodoisamba D, et al. Characteristics of indoor PM _2.5 concentration in Gers using coal stoves in Ulaanbaatar, Mongolia. Int J Environ Res Public Health. 2018;15(11):2524. https://doi.org/10.3390/ijerph15112524.CrossRefPubMedCentral

39.

Naranbat N, Nymadawa P, Schopfer K, Rieder HL. Seasonality of tuberculosis in an Eastern-Asian country with an extreme continental climate. Eur Respir J. 2009;34(4):921–5. https://doi.org/10.1183/09031936.00035309.CrossRefPubMed

40.

Fares A. Seasonality of tuberculosis. J Glob Infect Dis. 2011;3(1):46–55. https://doi.org/10.4103/0974-777X.77296.CrossRefPubMedPubMedCentral

41.

Demaio AR, Nehme J, Otgontuya D, Meyrowitsch DW, Enkhtuya P. Tobacco smoking in Mongolia: findings of a national knowledge, attitudes and practices study. BMC Public Health. 2014;14(1):213. https://doi.org/10.1186/1471-2458-14-213.CrossRefPubMedPubMedCentral

42.

Chan ED, Kinney WH, Honda JR, Bishwakarma R, Gangavelli A, Mya J, et al. Tobacco exposure and susceptibility to tuberculosis: is there a smoking gun? Tuberculosis (Edinb). 2014;94(6):544–50. https://doi.org/10.1016/j.tube.2014.08.010.CrossRefPubMed

43.

Leung CC, Lam TH, Ho KS, Yew WW, Tam CM, Chan WM, et al. Passive smoking and tuberculosis. Arch Intern Med. 2010;170(3):287–92. https://doi.org/10.1001/archinternmed.2009.506.CrossRefPubMed

44.

Lindsay RP, Shin SS, Garfein RS, Rusch ML, Novotny TE. The association between active and passive smoking and latent tuberculosis infection in adults and children in the united states: results from NHANES. PloS one. 2014;9(3):e93137. https://doi.org/10.1371/journal.pone.0093137.CrossRefPubMedPubMedCentral

45.

Deng J, Su C, Li J, Wang M, Abuaku BK, et al. Impact of passive smoking, cooking with solid fuel exposure, and MBL/MASP-2 gene polymorphism upon susceptibility to tuberculosis. Int J Infect Dis. 2014;29:1–6.CrossRefPubMed

46.

Zhang J, Smith KR. Indoor air pollution: a global health concern. Br Med Bull. 2003;68(1):209–25. https://doi.org/10.1093/bmb/ldg029.CrossRefPubMed

Title: Association between household solid fuel use and tuberculosis: cross-sectional data from the Mongolian National Tuberculosis Prevalence Survey
Authors: Munkhjargal Dorjravdan
Katsuyasu Kouda
Tsolmon Boldoo
Naranzul Dambaa
Tugsdelger Sovd
Chikako Nakama
Toshimasa Nishiyama
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Tuberculosis
Tuberculosis
Published in: Environmental Health and Preventive Medicine / Issue 1/2021
Print ISSN: 1342-078X
Electronic ISSN: 1347-4715
DOI: https://doi.org/10.1186/s12199-021-00996-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Association between household solid fuel use and tuberculosis: cross-sectional data from the Mongolian National Tuberculosis Prevalence Survey

Abstract

Background

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusion

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