Indoor pollution as an occupational risk factor for tuberculosis among women: a population-based, gender oriented, case-control study in Southern Mexico.
BACKGROUND
Indoor air pollution produced by biomass cooking fuels in developing countries has been associated with acute and chronic lower respiratory diseases, but has not been identified as an occupational exposure among women.


OBJECTIVE
To examine the relationship between the use of biomass cooking fuels (mainly wood) and tuberculosis (TB) among women living in rural areas in Southern Mexico.


METHODS
We conducted a population based case-control study in the health jurisdiction of Orizaba, Mexico. Cases were all incident female pulmonary TB patients, with Mycobacterium tuberculosis in sputum, living in communities with fewer than 15,000 inhabitants, diagnosed between March 1995 and April 2003. Woodsmoke exposure was assessed by applying a standardized questionnaire (ATS-DLD-78 questionnaire). Controls were randomly selected from sex-matched neighbors. Appropriate IRB approval was obtained.


RESULTS
42 TB cases and 84 community controls were recruited. Multivariate assessment showed that more than 20 years of exposure to smoke from biomass fuels was three times more frequent among cases than among controls [Odds ratio (OR): 3.3, 95% confidence interval (CI):1.06-10.30, p = 0.03], after controlling for age, body mass, household crowding, years of formal education and tobacco use.


CONCLUSIONS
We found a strong association between the use of biomass cooking fuels and tuberculosis among women in a community-based, case-control study. Results of this study are intended to provide evidence to policy makers, community leaders and the general public on the importance of implementing gender oriented interventions that decrease the use of biomass fuels in poor communities in developing countries.
García-Sancho
Ma Cecilia
MC
Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas".
García-García
Lourdes
L
Báez-Saldaña
Renata
R
Ponce-De-León
Alfredo
A
Sifuentes-Osornio
José
J
Bobadilla-Del-valle
Miriam
M
Ferreyra-Reyes
Leticia
L
Cano-Arellano
Bulmaro
B
Canizales-Quintero
Sergio
S
Palacios-Merino
Luz del Carmen
Ldel C
Juárez-Sandino
Luis
L
Ferreira-Guerrero
Elizabeth
E
Cruz-Hervert
Luis Pablo
LP
Small
Peter M
PM
Pérez-Padilla
José Rogelio
JR
D000328:Adult; D016902:Air Pollution, Indoor / Q000009:adverse effects*; D056804:Biofuels / Q000009:adverse effects*; D016022:Case-Control Studies; D003296:Cooking; D005260:Female; D006801:Humans; D008800:Mexico; D016273:Occupational Exposure / Q000009:adverse effects*; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000209:etiology*
D056804:Biofuels