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Association of childhood pulmonary tuberculosis with exposure to indoor air pollution: a case control study

Journal article
Authors N. Jafta
P. M. Jeena
Lars Barregård
R. N. Naidoo
Published in BMC Public Health
Volume 19
ISSN 1471-2458
Publication year 2019
Published at Institute of Medicine, Department of Public Health and Community Medicine, Section of Occupational and environmental medicine
Language en
Links dx.doi.org/10.1186/s12889-019-6604-...
Keywords Indoor air pollution, Childhood tuberculosis, Dampness, Secondhand smoke, Exposure assessment, particulate matter, solid-fuel, biomass fuel, risk-factors, children, smoke, households, patterns, disease, durban, Public, Environmental & Occupational Health
Subject categories Health Sciences

Abstract

BackgroundCrude measures of exposure to indicate indoor air pollution have been associated with the increased risk for acquiring tuberculosis. Our study aimed to determine an association between childhood pulmonary tuberculosis (PTB) and exposure to indoor air pollution (IAP), based on crude exposure predictors and directly sampled and modelled pollutant concentrations.MethodsIn this case control study, children diagnosed with PTB were compared to children without PTB. Questionnaires about children's health; and house characteristics and activities (including household air pollution) and secondhand smoke (SHS) exposure were administered to caregivers of participants. A subset of the participants' homes was sampled for measurements of PM10 over a 24-h period (n=105), and NO2 over a period of 2 to 3weeks (n=82). IAP concentrations of PM10 and NO2 were estimated in the remaining homes using predictive models. Logistic regression was used to look for association between IAP concentrations, crude measures of IAP, and PTB.ResultsOf the 234 participants, 107 were cases and 127 were controls. Pollutants concentrations (g/m(3)) for were PM10 median: 48 (range: 6.6-241) and NO2 median: 16.7 (range: 4.5-55). Day-to-day variability within- household was large. In multivariate models adjusted for age, sex, socioeconomic status, TB contact and HIV status, the crude exposure measures of pollution viz. cooking fuel type (clean or dirty fuel) and SHS showed positive non-significant associations with PTB. Presence of dampness in the household was a significant risk factor for childhood TB acquisition with aOR of 2.4 (95% CI: 1.1-5.0). The crude exposure predictors of indoor air pollution are less influenced by day-to-day variability. No risk was observed between pollutant concentrations and PTB in children for PM10 and NO2.ConclusionOur study suggests increased risk of childhood tuberculosis disease when children are exposed to SHS, dirty cooking fuel, and dampness in their homes. Yet, HIV status, age and TB contact are the most important risk factors of childhood PTB in this population.

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