Health Impact of Biomass Fuel Use in Rural India

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Health Impact of Biomass Fuel Use in Rural India

Twisha Lahiri Manas Ranjan Ray
Chittaranjan National Cancer Institute,
Kolkata, India
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Biomass Fuel Use in India

• Traditional biomass fuel used by
• 578 million (78) people
• constitutes 80 of domestic
• energy consumption
• Annual consumption
• Wood crop residues- 300 million
• tonnes
• Dung 100 million tonnes

Urban-285 million (27.8)
Rural-742 million (72.2)

Energy efficiency capital cost wood gt crop
residue gt dung Scarcity of wood cause switch to
inferior fuel
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Biofuel Emission Concentration 10-100 times
NAAQS dung gt crop
residues gt wood Composition Complex mixture
Gases CO, NOx, SO2 etc.
HC VOC Benzene, Xylene,
1,3-Butadiene etc. PAH
Benzo-a-pyrene, Benz-anthracene
Metals Pb, Fe, Cd, Zn, Ni
Particulate matter Of different size
and
composition Exposure high - short
duration ( 2-4hrs / day) Target group women
children The health effects are the impact of
this complex mixture rather than a particular
pollutant.

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• The Biofuel Menance
• 600,000 (approx.) premature deaths / yr. (5.3)
  among women children in India (Smith et al,
  2002)
• Biofuel use associated with
• acute respiratory infection
• COPD
• cancer
• tuberculosis
• adverse pregnancy outcomes
• blindness / cataract heart disease
• Aim of the study To assess the Pulmonary
• systemic effects of exposure to biomass fuel
  
• emission by pollution sensitive biomarkers
  to
• develop Medical Air Pollution Intervention
  
• Strategies

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• Study Approach
• Population - 850 women of rural West Bengal
  Uttaranchal, age socioeconomic status
  matched 300 rural women of WB using LPG
  (controls)
• Questionnaires - personal history respiratory
  symptoms
• Clinical examination lung function test by
  Spirometry
• Sampling laboratory investigation
• Sputum- alveolar macrophage responses
  (numerical,
• structural functional)sputum
  cytology and
• infiltrating leukocytes
• Buccal mucosa- nuclear abnormalities and
• micronucleus
• Blood- Hematological alteration
• Blood biochemistry
• Immune response- T cells, B
  cells, NK cells
• Platelet activation
  status by FACS
• Statistical analysis chi-square test, logistic
  regression etc.
• SYSTAT 9.0 (SPSS,
  Chicago)

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Respiratory Symptoms
URS
Control Biomass user
LRS
Other Symptoms
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Lung Function
Impairment

• 10,000 15,000 liters of air enter an adult
• lung / day. Target 300 million alveolus
• Increase in conc. of pollutants increases
• toxic insult to the lung
• From alveolus pollutants travel via lymph
• or blood to diff. organs

of individuals
Control
Biomass user
Normal Restrictive Obstructive
Combined
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Alveolar Macrophage (AM) Response

• AM A Biomarker of Pollution Effect - Interact
  directly with toxic particles and gases -
  phagocytosis, migration and secretion pivotal in
  pathogenesis of lung diseases
• Increase in number enlargement
• accommodate high particle load
• Particle overload and disintegration release of
  particles initiation of lung injury

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Functional Alteration of AM
High acid phosphatase activity activation of AM
Release of elastase by AM degradation of elastin
leading to emphysema
Heavy Iron deposition in AM covert pulmonary
hemorrhage?
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Sputum Cytology Alterations - 1
Control
Biomass user
Eosinophilia allergy bronchitis asthma


Neutrophilia airway obstruction
Inflammation Lymphocytosis viral infection
-
Cells / hpf
Cells / hpf
Cells / hpf
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Sputum Cytology Alterations - 2
Control
Biomass user
Metaplasia with atypia carcinogen Insult
faulty repair-risk for COPD lung cancer


Ciliated columnar epithelial cells
damage to the bronchial wall Koilocyte (with
perinuclear halo) HPV
infection
of individuals
of individuals
of individuals
plt0.05
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Nuclear Anomalies biomarker of Genotoxicity
Micronucleus
MN / 1000 cells
Control
Biomass user
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Hematological Immune Alterations

• Abnormal hematology
• Decrease in Hb, RBC in 26 individuals
• Increase in WBC in 30
• Increase in Platelet P-selectin in 57
• Decrease in antioxidant in 52 cases
• Altered immunity
• 31 supression of CD4 Th,
• 27 increase in CD8 Tc
• CD4CD8 ratio 21 11
• 47 decrease in CD19 B cells
• 98 increase in CD1656 NK cells

P - selectin
of platelet
Superoxide Dismutase
U / ml
Control
Biomass user
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• Summary
• Exposure to biomass fuel emissions in rural women
  cause significant increase in
• Respiratory Symptoms
• Lung Function Impairment
• Numerical, Structural Functional alteration of
  AM
• Systemic alterations
• Genotoxicity
• Hematological Metabolic alterations
• Immune alterations (vulnerable to infections)
• Some of these alterations are reversible proper
  intervention measures can prevent the development
  of irreversible diseases like COPD cancer

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• The health consequences of millions of rural
  Indian women children warrant immediate
  implementation of intervention measures
• cleaner energy options alternative fuels
• improved stoves
• improved ventilation / chimneys
• awareness campaigns on health
• behavioral changes
• early medical intervention to prevent
• diseases like tuberculosis, COPD,
• blindness cancer