Tobacco smoking, passive smoking, and indoor air pollution from biomass fuels have been implicated as risk factors for tuberculosis (TB) infection, disease, and death. Tobacco smoking and indoor air pollution are persistent or growing exposures in regions where TB poses a major health risk.

Use of biomass takes high toll

A major challenge facing developing countries is how to allocate scarce capital, especially public capital, for the provision of basic services. Electrification, as part of an integrated service delivery package, is both a large draw on public funds and also an important catalyst for economic development. One of the major benefits of electrification, but one that is not included in traditional cost-benefit analysis, is the avoided health costs of fuels such as wood, coal and paraffin. March 2005

Despite many studies looking at levels of indoor air pollution, successful initiatives to reduce the burden of ill health are few. One reason may be some commonly held beliefs, especially among those not directly involved in household energy, on some key issues in this field. ITDG has been collaborating on smoke alleviation with the University of Liverpool and other groups internationally for several years. This discussion is based on approaches adopted through two on-going projects funded by the UK Department for International Development (DFID) in Kenya, Nepal and Sudan. March 2005

Indoor air pollution is potentially a very serious environmental and public health problem in India. In poor communities, with the continuing trend in biofuel combustion coupled with deteriorating housing conditions, the problem will remain for some time to come.

The detrimental effects of air pollution on health have been recognized for most of the last century. Effective legislation has led to a change in the nature of the air pollutants in outdoor air in developed countries, while combustion of raw fuels in the indoor environment remains a major health hazard in developing countries. The mechanisms of how these pollutants exert their effects are likely to be different, but there is emerging evidence that the toxic effects of new photochemical pollutants such as nitrogen dioxide are likely to be related to infection.

Due to combustion of solid fuels, indoor air pollution seems to be a major contributor to disease in India, but few quantitative exposure assessment studies are available. This study quantified daily average concentrations of respirable particulates in 420 rural homes of Andhra Pradesh and recorded time activity data of 1400 individuals to reconstruct 24-hour average exposures.

This paper estimates the economic burden of respiratory illness in rural UP (Uttar Pradesh), a state in North India. This is based on a large comprehensive survey covering a sample of 7564 households in 6 districts and 51 villages in UP. The economic value of the days lost due to illness in one month is 4233 million rupees. Cleaner fuels, health education and better health care can avoid some of these expenditures.

In 2000, a risk assessment of IAP (indoor air pollution) due to household use of solid fuels in India was published in the Proceedings of the National Academy of Sciences (Smith 2000). Employing a different and more systematic method than used before, it estimated the premature deaths and illnesses resulting from household epidemiological studies of developing countries, which use solid fuels, to the Indian situation by employing the national Census report on percentage of household solid fuel use as the surrogate of exposure.