|BRIEF RESEARCH ARTICLE
|Year : 2019 | Volume
| Issue : 3 | Page : 258-260
Association of biomass fuel smoke exposure and hypertension among rural women of Bangladesh: A cross-sectional study
Nilima Barman1, M Atiqul Haque2, A K. M. Fazlur Rahman3, M Khalequzzaman2, Saidur R Mashreky4
1 Assistant Professor, Department of Clinical Pathology, Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
2 Associate Professor, Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
3 Professor, Department of Epidemiology, Bangladesh University of Health Sciences; Executive Director, Center for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh
4 Professor, Department of Noncommunicable Diseases, Bangladesh University of Health Sciences; Director, Department of Public Health Sciences, Center for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh
|Date of Web Publication||20-Sep-2019|
Department of Clinical Pathology, Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders, Shahabagh, Dhaka 1000
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Exposure to biomass fuel smoke has detrimental health effects causing chronic diseases. This study investigated the relationship between biomass fuel smoke exposure and hypertension among the rural Bangladeshi women. A total of 410 women aged 19–60 years were enrolled in this study during April–May 2017 who regularly cooked with biomass fuel in traditional cook stove for the past ≥1 year. Self-reported daily cooking hours and lifetime cooking experience of the participants were recorded, and their blood pressure was measured. Participants' age ≥40 years, parental history of hypertension, body mass index ≥25 kg/m2, and cumulative exposure to biomass smoke were found to be the significant risk factors of hypertension. Every 1 year increase in cumulative exposure to biomass smoke eventually exacerbated the risk of hypertension by 61% (adjusted odds ratio 1.61, 95% confidence interval: 1.16–2.22; P < 0.01). This study provides evidence that long-term exposure to biomass fuel smoke is associated with hypertension.
Keywords: Bangladesh, biomass fuel, hypertension, rural women
|How to cite this article:|
Barman N, Haque M A, Rahman A K, Khalequzzaman M, Mashreky SR. Association of biomass fuel smoke exposure and hypertension among rural women of Bangladesh: A cross-sectional study. Indian J Public Health 2019;63:258-60
|How to cite this URL:|
Barman N, Haque M A, Rahman A K, Khalequzzaman M, Mashreky SR. Association of biomass fuel smoke exposure and hypertension among rural women of Bangladesh: A cross-sectional study. Indian J Public Health [serial online] 2019 [cited 2020 Dec 2];63:258-60. Available from: https://www.ijph.in/text.asp?2019/63/3/258/267226
An increasing trend of hypertension prevalence has been observed in Bangladesh, with a varying range of 8%–26%., Recent studies found the risk of developing hypertension with biomass fuel smoke exposure., Biomass fuel is widely used for cooking in rural areas of Bangladesh, which causes heavy indoor air pollution., This situation makes rural women susceptible to developing chronic diseases, as they spend most of their time indoors and are engaged in cooking., This study aimed to find the association of biomass fuel smoke exposure with hypertension among the rural women of Bangladesh.
This cross-sectional study was carried out in an injury-based surveillance area of Center for Injury Prevention and Research, Bangladesh (CIPRB) at Raiganj subdistrict of Sirajganj, Bangladesh, from April to May 2017. Within this area, there are 31,971 households with 147,072 population where every household has a unique identification number. The sample size was calculated using the formula, Sample size was calculated using the following formula, n = Zα/22 p(1-p)/d2. Here, Z=1.96, P=0.264 (considering prevalence of hypertension 26.4% from a previous study), and d (margin of error)=0.04. The calculated sample size was 466, while 56 were nonresponders. Simple random technique was used to select the households. One woman from each household who cooked regularly with biomass fuel in traditional cookstoves for the past ≥1 year was selected by lottery method. Pregnant and smoking women were excluded.
A semistructured questionnaire was used for data collection. Biomass fuel smoke exposure was measured by asking self-reported daily cooking duration (hours) and the lifetime cooking experience (years). The cumulative exposure to biomass fuel smoke was calculated by multiplying the daily cooking hours with 365 and again multiplying it by lifetime cooking years. The result was later transformed into years. The blood pressure was measured and recorded thrice after 10 min interval of each measurement by a digital blood pressure monitor (K2-1702; Tanaka Sangyo Co. Ltd, Tokyo, Japan). The average of the second and third measurements was taken for analysis. Hypertension was defined as an individual with systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and/or taking antihypertensive medication. Two graduates having similar work experiences were assigned for data collection through electronic device using Research Electronic Data Capture web-based application. Ethical clearance was obtained from the Ethical Review Committee of CIPRB (CIPRB/ERC/2017/21).
Categorical variables were presented in frequency and percentage whereas continuous variables were presented in mean and standard deviation (SD). Logistic regression was done to estimate the risk factors for hypertension and expressed by crude odds ratios (cORs) and associated 95% confidence intervals (CI). Variables having significant associations with hypertension were further assessed in a multivariate regression model and expressed by adjusted OR (adj OR). Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp) was used for the analysis. P < 0.05 was considered statistically significance.
Approximately two-thirds of the respondents were under 40 years of age and 72% had nonformal to primary-level (1–5 grade) education. More than three-quarters women depended on plant origin cooking fuel, i.e., wood and crop residues [Table 1].
|Table 1: Sociodemographic characteristics of the study population (n=410)|
Click here to view
The mean lifetime cooking experience was 19.74 years. Within this period, participants were cumulatively exposed to biomass fuel smoke for 2.56 (SD, 1.19) years, while the mean daily cooking duration was 3.11 (SD, 0.71) hours. The overall prevalence of hypertension was 13.7% (95% CI, 10.4%–17.0%). A statistically significant positive correlation between age and hypertension was found in this study (Spearman correlation, r = 0.289, P < 0.0001).
In univariate analysis, hypertension was found significantly associated with respondents' age ≥40 years (cOR 5.23), smokeless tobacco (cOR 2.09), parental history of hypertension (cOR 2.58), body mass index (BMI) ≥25 kg/m2 (cOR 2.84), and cumulative exposure to biomass fuel smoke (cOR 2.07). However, in multivariate analysis, cumulative exposure to biomass fuel smoke, age ≥40 years, parental history of hypertension, and BMI ≥25 kg/m2 were found to be the significant risk factors [Table 2].
|Table 2: Association of hypertension with sociodemographic and behavioral factors|
Click here to view
The strength of the analysis was to have an association between hypertension and self-reported exposure to biomass fuel smoke among rural women after adjusting with their age, history of smokeless tobacco, parental history of hypertension, and BMI.
Lee et al. showed a significant association between hypertension and biomass fuel smoke in China (OR: male vs. female; 1.54 vs. 2.00), which is incongruent with this study. Similarly, Burroughs Peña et al. documented that biomass fuel smoke exposure had a significant relationship with both prehypertension (adjusted relative risk [RR] 5.0, 95% CI 2.6–9.9) and hypertension (adjusted RR 3.5, 95% CI 1.7–7.0) in Peru. A similar finding was also emanated from a study conducted among rural women in India.
This cross-sectional study indicated potential association rather than establishing a cause-effect relationship. As the cooking time was self-reported, there might be recall bias, but some of the instances were cross-validated. This study was conducted in a rural area and only women were studied, so the result could not be generalized.
Chronic exposure to biomass fuel smoke has a significant contributing effect to develop hypertension. National policy should be taken to use cleaner fuel within affordability.
The authors wish to thank the women for their participation in this survey and also thankful to the Ministry of Science and Technology, Bangladesh, for their partial financial support (Grant no. 39.00.0000.09.02.69.16-17/Medi-S-241).
Financial support and sponsorship
Ministry of Science and Technology, Bangladesh, provided partial financial support (Grant no. 39.00.0000.09.02.69.16-17/Medi-S-241).
Conflicts of interest
There are no conflicts of interest.
| References|| |
Chowdhury MA, Uddin MJ, Haque MR, Ibrahimou B. Hypertension among adults in Bangladesh: Evidence from a national cross-sectional survey. BMC Cardiovasc Disord 2016;16:22.
Rahman MM, Akter S, Jung J, Rahman MS, Sultana P. Trend, projection, and appropriate body mass index cut-off point for diabetes and hypertension in Bangladesh. Diabetes Res Clin Pract 2017;126:43-53.
Lee MS, Hang JQ, Zhang FY, Dai HL, Su L, Christiani DC. In-home solid fuel use and cardiovascular disease: A cross-sectional analysis of the Shanghai Putuo study. Environ Health 2012;11:18.
Dutta A, Mukherjee B, Das D, Banerjee A, Ray MR. Hypertension with elevated levels of oxidized low-density lipoprotein and anticardiolipin antibody in the circulation of premenopausal Indian women chronically exposed to biomass smoke during cooking. Indoor Air 2011;21:165-76.
Smith K, Mehta S, Maeusezahl-Feuz M. Indoor smoke from household solid fuels. In: Ezzati M, Lopez AD, Rodgers A and Murrary CJ, editors. Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors. Geneva: World Health Organization; 2004. p. 1435-93.
Kim KH, Jahan SA, Kabir E. A review of diseases associated with household air pollution due to the use of biomass fuels. J Hazard Mater 2011;192:425-31.
Miah MD, Al Rashid H, Shin MY. Wood fuel use in the traditional cooking stoves in the rural floodplain areas of Bangladesh: A socio-environmental perspective. Biomass Bioenergy 2009;33:70-8.
Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves JW, Hill MN, et al.
Recommendations for blood pressure measurement in humans: An AHA scientific statement from the council on high blood pressure research professional and public education subcommittee. J Clin Hypertens (Greenwich) 2005;7:102-9.
Burroughs Peña M, Romero KM, Velazquez EJ, Davila-Roman VG, Gilman RH, Wise RA, et al.
Relationship between daily exposure to biomass fuel smoke and blood pressure in high-altitude Peru. Hypertension 2015;65:1134-40.
[Table 1], [Table 2]