Natural ventilation reduces high TB transmission risk in traditional homes in rural KwaZulu-Natal, South Africa
Open accessAbstract
Background: Transmission of drug susceptible and drug resistant TB occurs in health care facilities, and community and households settings, particularly in highly prevalent TB and HIV areas. There is a paucity of data regarding factors that may affect TB transmission risk in household settings. We evaluated air exchange and the impact of natural ventilation on estimated TB transmission risk in traditional Zulu homes in rural South Africa. Methods: We utilized a carbon dioxide decay technique to measure ventilation in air changes per hour (ACH). We evaluated predominant home types to determine factors affecting ACH and used the Wells-Riley equation to estimate TB transmission risk. Results: Two hundred eighteen ventilation measurements were taken in 24 traditional homes. All had low ventilation at baseline when windows were closed (mean ACH = 3, SD = 3.0), with estimated TB transmission risk of 55.4% over a ten hour period of exposure to an infectious TB patient. There was significant improvement with opening windows and door, reaching a mean ACH of 20 (SD = 13.1, p < 0.0001) resulting in significant decrease in estimated TB transmission risk to 9.6% (p < 0.0001). Multivariate analysis identified factors predicting ACH, including ventilation conditions (windows/doors open) and window to volume ratio. Expanding ventilation increased the odds of achieving ≥12 ACH by 60-fold. Conclusions: There is high estimated risk of TB transmission in traditional homes of infectious TB patients in rural South Africa. Improving natural ventilation may decrease household TB transmission risk and, combined with other strategies, may enhance TB control efforts.
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Like COVID-19, TB is an airborne disease spread through infectious aerosols generated by infected people; transmission risk was higher in South African homes with poor ventilation.
“Like COVID-19, TB is an airborne disease spread through infectious aerosols generated by infected people (140); for example, transmission risk was higher in South African homes with poor ventilation (98).”
From Review of the Impact of Housing Quality on Inequalities in Health and Well-Being (2023) · cites this paper as [98]
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- Authors
- Lygizos, M., Shenoi, S. V., Brooks, R. P., Bhushan, A., Brust, J. C., Zelterman, D., Deng, Y., Northrup, V., Moll, A. P., & Friedland, G. H.
- Affiliations
- Yale University (US)
- Harvard University (US)
- Albert Einstein College of Medicine (US)
- Corresponding author
- Shenoi, Sheela V
- ORCID
- Venue
- BMC Infectious Diseases
- Published
- 2013-07-01
- Volume
- 13
- Issue
- 1
- Pages
- 300-300
- ISSN
- 1471-2334 (ISSN-L)
- PMC
- PMC3716713
- OpenAlex
- W2120557433
- Cited by
- 51
- References
- 25
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 2 · 2022: 7 · 2021: 3 · 2020: 7 · 2019: 3 · 2018: 3 · 2017: 6 · 2016: 2 · 2015: 7 · 2014: 5 · 2013: 1
- FWCI
- 4.06
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Infectious Diseases (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Funders
- Doris Duke Charitable Foundation
- Gilead Sciences
- Gilead Foundation
- Georgia Clinical and Translational Science Alliance (UL1 RR024139)
- Center for AIDS Research, University of Washington
- National Institute of Mental Health (P30MH062294)
- National Institute of Allergy and Infectious Diseases (K23AI089260, P30AI051519, K23AI083088)
- Fogarty International Center (R24TW007988, D43TW010540)
- National Center for Research Resources (UL1RR024139)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Keywords
- tuberculosis transmission, household transmission, natural ventilation, air exchange rate, Wells-Riley equation, window openings, rural housing, KwaZulu-Natal
- MeSH terms
- Air Movements, Analysis of Variance, Housing, Humans, Risk, Risk Factors, South Africa, Temperature, Tuberculosis, Ventilation, Multivariate Analysis
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