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Cited by 26Energy and Environment ImpactsAir Quality and Health ImpactsIndoor Air Quality and Microbial Exposure

The association of household fine particulate matter and kerosene with tuberculosis in women and children in Pune, India

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Elf, Jessica L, Kinikar, Aarti, Khadse, Sandhya, Mave, Vidya, Suryavanshi, Nishi, Gupte, Nikhil, Kulkarni, Vaishali, Patekar, Sunita +7 more·2019·Occupational and Environmental Medicine
DOI 10.1136/oemed-2018-105122PMC PMC12794403
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Abstract

Objectives: Household air pollution (HAP) is a risk factor for respiratory disease, however has yet to be definitively associated with tuberculosis (TB). We aimed to assess the association between HAP and TB. Methods: A matched case–control study was conducted among adult women and children patients with TB and healthy controls matched on geography, age and sex. HAP was assessed using questionnaires for pollution sources and 24-hour household concentrations of particulate matter <2.5 μm in diameter (PM 2.5). Results: In total, 192 individuals in 96 matched pairs were included. The median 24-hour time-weighted average PM 2.5 was nearly seven times higher than the WHO’s recommendation of 25 µg/m 3, and did not vary between controls (179 µg/m 3; IQR: 113–292) and cases (median 157 µg/m 3; 95% CI 93 to 279; p=0.57). Reported use of wood fuel was not associated with TB (OR 2.32; 95% CI 0.65 to 24.20) and kerosene was significantly associated with TB (OR 5.49, 95% CI 1.24 to 24.20) in adjusted analysis. Household PM 2.5 was not associated with TB in univariate or adjusted analysis. Controlling for PM 2.5 concentration, kerosene was not significantly associated with TB, but effect sizes ranged from OR 4.30 (95% CI 0.78 to 30.86; p=0.09) to OR 5.49 (0.82 to 36.75; p=0.08). Conclusions: Use of kerosene cooking fuel is positively associated with TB in analysis using reported sources of exposure. Ubiquitously high levels of particulates limited detection of a difference in household PM 2.5 between cases and controls.

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  • Studies have suggested that kerosene-based emissions are more toxic than biomass-fuel emissions.

    “While studies have suggested that kerosene-based emissions are more toxic than biomass-fuel based emissions 25–28”

    From Effect of a solar lighting intervention on fuel-based lighting use and exposure to household air pollution in rural Uganda: A randomized controlled trial (2022) · cites this paper as [27]

    The Discussion (page unavailable) describes potentially harmful kerosene emissions, including ultrafine particles and combustion products linked to adverse respiratory effects. It does not say that kerosene-based emissions are more toxic than biomass-fuel emissions; the Results compare fuel use in relation to TB, not emission toxicity. (LLM, conf=0.78)

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  • The relationship between kerosene use and tuberculosis is consistent with Pokhrel et al, Patel et al and Elf et al, who find increased tuberculosis risk for those who use kerosene as a lighting source.

    “This relationship is consistent with Pokhrel et al, Patel et al and Elf et al who find increased TB risk for those who use kerosene as a lighting source.15 17 20”

    From Household air pollution exposure and risk of tuberculosis: a case–control study of women in Lilongwe, Malawi (2024) · cites this paper as [20]

    The Results report a positive association between kerosene used for cooking and TB, not a finding for kerosene used for lighting. The Discussion reports a stronger lighting-fuel association from a study in Nepal, so the paper supports the general relationship but not its attribution to Elf et al. as their own lighting-fuel finding. (LLM, conf=0.87)

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  • Elf et al found a relationship between kerosene use and tuberculosis that goes away after controlling for PM2.5, suggesting that the increase in PM2.5 is an important pathway between kerosene use and tuberculosis.

    “They find a relationship between kerosene use and TB that goes away after controlling for PM2.5 suggesting that the increase in PM2.5 is perhaps an important pathway between kerosene use and TB.”

    From Household air pollution exposure and risk of tuberculosis: a case–control study of women in Lilongwe, Malawi (2024) · cites this paper as [20]

    The Results report that kerosene use was significantly associated with TB in an adjusted model, but was no longer statistically significant in models controlling for household PM2.5; its estimated association remained positive. The Discussion says kerosene use does not significantly contribute to 24-hour household PM2.5 measurements, so the paper does not support increased measured PM2.5 as the pathway linking kerosene to TB. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • Observational research links household kerosene use to tuberculosis, unlike biomass fuel use, and also to acute lower respiratory infection.

    “observational studies showing strong associations between household kerosene use and tuberculosis but not household biomass fuel use and tuberculosis 27,28, and between household kerosene use and acute lower respiratory infection 29.”

    From Effect of a solar lighting intervention on fuel-based lighting use and exposure to household air pollution in rural Uganda: A randomized controlled trial (2022) · cites this paper as [27]

  • Elf et al found that wood fuel use in India was not associated with tuberculosis but that use of kerosene was.

    “Elf et al found that wood fuel use in India was not associated with TB but that use of kerosene was.20”

    From Household air pollution exposure and risk of tuberculosis: a case–control study of women in Lilongwe, Malawi (2024) · cites this paper as [20]

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Research works printed but not linked: 3

  1. [1]World Health Organization. WHO Guidelines for Indoor Air Quality: Selected Pollutants. Geneva, 2010. 23741784
  2. [7]World Health Organization. Air quality guidelines. Global update 2005. Particulate matter, ozone, nitrogen dioxide and sulfur dioxide Summary of risk assessment, 2005. 34662007
  3. [33]World Health Organization. WHO guidelines for indoor air quality: household fuel combustion. Geneva, Switzerland, 2014. 25577935

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Authors
Elf, J. L., Kinikar, A., Khadse, S., Mave, V., Suryavanshi, N., Gupte, N., Kulkarni, V., Patekar, S., Raichur, P., Paradkar, M., Kulkarni, V., Pradhan, N., Breysse, P. N., Gupta, A., & Golub, J. E.
Affiliations
  • Johns Hopkins University (US)
  • B. J. Medical College & Sassoon Hospital (IN)
Corresponding author
Elf, Jessica L
ORCID
Venue
Occupational and Environmental Medicine
Publisher
BMJ
Published
2018-09-07
Volume
76
Issue
1
Pages
40-47
ISSN
  • 0007-1072 (ISSN-L)
  • 1351-0711
  • 1470-7926
DOI
10.1136/oemed-2018-105122
PMC
PMC12794403
OpenAlex
W2890508954
Cited by
26
References
30
Citations by year
2026: 2 · 2025: 1 · 2024: 6 · 2023: 2 · 2022: 5 · 2021: 1 · 2020: 4 · 2019: 4 · 2017: 1
FWCI
0.84
Type
journal article
Language
en
Open access
Locations
  • Occupational and Environmental Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • National Institute of Allergy and Infectious Diseases
  • Government of India Department of Biotechnology
  • Gilead Foundation
  • Ujala Foundation
  • Fogarty International Center
  • Office of AIDS Research
  • Indian Council of Medical Research
  • National Institutes of Health
Topics
  • Physical Sciences › Environmental Science › Pollution › Energy and Environment Impacts
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
Keywords
household air pollution, tuberculosis, PM2.5, fuelwood, women, children, respiratory diseases, Pune
MeSH terms
Child Health, Adult, Child, Preschool, Cooking, Environmental Monitoring, Family Characteristics, Female, Humans, India, Infant, Kerosene, Male, Poverty, Seasons, Tuberculosis, Wood, Multivariate Analysis, Logistic Models, Case-Control Studies, Women's Health, Air Pollution, Indoor, Particulate Matter, Young Adult

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