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Estimating the burden of disease attributable to indoor air pollution from household use of solid fuels in South Africa in 2000

Unmeasured confounders are factors that influencemortality and vary with time in amanner that is similar to air pollution. These factors produce seasonal and long-termtrends inmortality that can confound the relationship between mortality and air pollution. Influenza and respira- tory infectionsmight reasonably be considered among themost important, usually unmeasured or not readily available confounders which produce seasonal patterns in mortality. Typically, epidemic respiratory infections occur from late autumn to early spring and influenza epidemics occur in the same interval but with highly variable timing. The net effect of a respiratory virus is to increase mortality overall, explaining much of the higher mortality in winter months. Since air pollution levels. | Original Articles Estimating the burden of disease attributable to indoor air pollution from household use of solid fuels in South Africa in 2000 Rosana Norman Brendon Barnes Angela Mathee Debbie Bradshaw and the South African Comparative Risk Assessment Collaborating Group Objectives. To estimate the burden of respiratory ill health in South African children and adults in 2000 from exposure to indoor air pollution associated with household use of solid fuels. Design. World Health Organization comparative risk assessment CRA methodology was followed. The South African Census 2001 was used to derive the proportion of households using solid fuels for cooking and heating by population group. Exposure estimates were adjusted by a ventilation factor taking into account the general level of ventilation in the households. Population-attributable fractions were calculated and applied to revised burden of disease estimates for each population group. Monte Carlo simulation-modelling techniques were used for uncertainty analysis. Setting. South Africa. Subjects. Black African coloured white and Indian children under 5 years of age and adults aged 30 years and older. Outcome measures. Mortality and disability-adjusted life years Although attention to air pollutant emissions is dominated by outdoor sources human exposure is a function of the level of pollution in places where people spend most of their time.1-4 Human exposure to air pollution is therefore dominated by the indoor environment. Most research into indoor air pollution has focused on sources that are particularly relevant in developed countries such as environmental tobacco smoke volatile organic compounds from furnishings and radon from soil.5 6 This article focuses on the use of solid fuels for cooking and heating which is probably the largest traditional source of indoor air pollution globally - nearly half the world continues to cook with solid fuels such as dung wood coal and agricultural residues. This .