title: Wood smoke exposure, poverty and impaired lung function in Malawian adults.
abstract: BACKGROUND
  Household air pollution from burning biomass fuel is increasingly recognised as a major global health concern. Biomass smoke is associated with chronic obstructive pulmonary disease (COPD) in Asian and Central American countries, but there are few data from Africa.
  
  
  METHODS
  We hypothesised that reported wood smoke as compared to charcoal smoke exposure would be associated with a reduction in forced expiratory volume in 1 second in Malawian adults. Volunteers from urban and rural locations performed spirometry and completed a questionnaire assessing lifestyle, including smoke exposure and symptoms.
  
  
  RESULTS
  In total, 374 adults were recruited; 61% were female; 160 cooked using charcoal and 174 used wood. Individuals who used wood as their main domestic fuel had significantly worse lung function than those who used charcoal. Significant factors associated with impaired lung function in the multivariate model were age, sex, height, wood smoke exposure, poverty, smoking and previous tuberculosis.
  
  
  CONCLUSIONS
  Our data suggest that wood smoke and poverty contribute to reduced lung function in rural Africans and that COPD is common in this population. The use of charcoal in rural populations may be relatively protective, and this idea merits further study. The risk factors for impaired lung function in Malawi are multiple and require more detailed characterisation to plan appropriate health interventions.
authors.affiliation: Malawi-Liverpool-Wellcome Clinical Research Laboratories, Universities of Malawi and Liverpool (UK), Blantyre, Malawi. duncan.fullerton@liverpool.ac.uk
authors.forename: D G
authors.initials: DG
authors.lastname: Fullerton
authors.forename: A
authors.initials: A
authors.lastname: Suseno
authors.forename: S
authors.initials: S
authors.lastname: Semple
authors.forename: F
authors.initials: F
authors.lastname: Kalambo
authors.forename: R
authors.initials: R
authors.lastname: Malamba
authors.forename: S
authors.initials: S
authors.lastname: White
authors.forename: S
authors.initials: S
authors.lastname: Jack
authors.forename: P M
authors.initials: PM
authors.lastname: Calverley
authors.forename: S B
authors.initials: SB
authors.lastname: Gordon
mesh_terms: D000328:Adult; D016902:Air Pollution, Indoor / Q000009:adverse effects*; D018533:Biomass; D002606:Charcoal; D003296:Cooking; D003430:Cross-Sectional Studies; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D011203:Poverty; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000209:etiology*; D012129:Respiratory Function Tests; D012307:Risk Factors; D012423:Rural Health; D012906:Smoke / Q000009:adverse effects*; D013147:Spirometry; D011795:Surveys and Questionnaires; D014504:Urban Health; D014934:Wood
chemical_list: D012906:Smoke; D002606:Charcoal