title: Tuberculosis and indoor biomass and kerosene use in Nepal: a case-control study.
abstract: BACKGROUND
  In Nepal, tuberculosis (TB) is a major problem. Worldwide, six previous epidemiologic studies have investigated whether indoor cooking with biomass fuel such as wood or agricultural wastes is associated with TB with inconsistent results.
  
  
  OBJECTIVE
  Using detailed information on potential confounders, we investigated the associations between TB and the use of biomass and kerosene fuels.
  
  
  METHODS
  A hospital-based case-control study was conducted in Pokhara, Nepal. Cases (n = 125) were women, 20-65 years old, with a confirmed diagnosis of TB. Age-matched controls (n = 250) were female patients without TB. Detailed exposure histories were collected with a standardized questionnaire.
  
  
  RESULTS
  Compared with using a clean-burning fuel stove (liquefied petroleum gas, biogas), the adjusted odds ratio (OR) for using a biomass-fuel stove was 1.21 [95% confidence interval (CI), 0.48-3.05], whereas use of a kerosene-fuel stove had an OR of 3.36 (95% CI, 1.01-11.22). The OR for use of biomass fuel for heating was 3.45 (95% CI, 1.44-8.27) and for use of kerosene lamps for lighting was 9.43 (95% CI, 1.45-61.32).
  
  
  CONCLUSIONS
  This study provides evidence that the use of indoor biomass fuel, particularly as a source of heating, is associated with TB in women. It also provides the first evidence that using kerosene stoves and wick lamps is associated with TB. These associations require confirmation in other studies. If using kerosene lamps is a risk factor for TB, it would provide strong justification for promoting clean lighting sources, such as solar lamps.
authors.affiliation: School of Public Health, University of California-Berkeley, Berkeley, California 94720-7360, USA.
authors.forename: Amod K
authors.initials: AK
authors.lastname: Pokhrel
authors.forename: Michael N
authors.initials: MN
authors.lastname: Bates
authors.forename: Sharat C
authors.initials: SC
authors.lastname: Verma
authors.forename: Hari S
authors.initials: HS
authors.lastname: Joshi
authors.forename: Chandrashekhar T
authors.initials: CT
authors.lastname: Sreeramareddy
authors.forename: Kirk R
authors.initials: KR
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D016902:Air Pollution, Indoor / Q000009:adverse effects*; D016022:Case-Control Studies; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007648:Kerosene / Q000633:toxicity*; D008875:Middle Aged; D009390:Nepal; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult
chemical_list: D007648:Kerosene