ABSTRACT
Wood smoke is a complex mixture of substance produced during the combustion of wood. The major emissions from wood stoves are carbon monoxide, organic gases, particulate matter, oxides of nitrogen and sulphur. Toxic compounds as well as carcinogenic substances are also produced like benzopyrenes, aldehydes, phenols, cresols etc.
Irritants of the lungs like oxides of nitrogen and sulphur, phenols, particulate particles cause inflammation of the air passages inevitably causing/leading to obstruction of the lungs and other more severe effects.
The aim of this study was to investigate the effect of wood smoke on some lung function test, cardiovascular parameters and haematological indices in women in Zaria, Nigeria.
This study was conducted on 60 female subjects grouped into 2, Group 1 (control group) n = 30 were women that used other sources of fuel for cooking. Group 2 (study group) n = 30 were women that work as cooks in restaurants and use wood as a source of fuel. They were all matched for age and height.
Cardiovascular parameters investigated were blood pressure, pulse rate and mean arterial blood pressure. The Mean + SEM of systolic and diastolic blood pressure of the two group (gp 1 & 2) were 113.67+ 2.65 and 111.17+ 3.44 mmHg and 76.00+2.15 and 75.00 + 2.46 mmHg respectively. Mean arterial blood pressure were 89.78+ 1.86 and 87.06+ 2.69 mmHg for the two groups and pulse rate was 75.60+ 1.29 and 77.93 + 1.56 beats/men respectively. There was no significant statistical difference in cardiovascular parameters between the two groups (P> 0.05).
6 Haematological indices such as packed cell volume for the two groups were 41.53+ 0.60 and 41.43 + 0.76. Haemoglobin concentration 13.84+0.20 and 13.81+ 0.25 for group 1 and 2 respectively. The mean + SEM of Differential white blood cell count, Neutrophils, lymphocytes, monocytes and Eosinophils for the two groups were 59.43+ 0.57 and 59.03+ 0.55, 31.87+0.67 and 32.50+ 0.79, 6.47+ 0.21 and 6.47+ 0.25, and 3.04+ 0.26 and 3.10+ 0.28 respectively. There were no significant difference found between the two groups (of the respective parameters) P > 0.05. The Mean +SEM of Respiratory function tests such as peak expiratory flow rate (PEFR) predicted and actual were 3.96+ 0.10 and 3.88+ 0.04, 4.87+ 0.13 and 4.43+ 0.12 respectively for the two groups. The Mean + SEM of forced expiratory volume in 1 second percent (FEV1%) ratio was found to be 81.83+ 1.33 and 78.39+ 1.61 for group 1 and 2 respectively.
There was no significant statistical difference in predicted peak expiratory flow rate and forced expiratory volume in 1 second percent ratio between the two groups (P > 0.05). There was a significant difference in actual peak expiratory flow rate between the two groups (P<0.05).
This result indicates that women using biomass fuel (wood) are more liable to have reduced pulmonary functions than women using kerosine or gas as shown by the reduction in PEFR.
TABLE OF CONTENT
Pages
Titlepage……………………………………………………………………………………………………………..
Declaration…………………………………………………………………………………………………………..
Certification……………………………………………………………………………………………………….
Acknowledgment……………………………………………………………………………………………….
Abstract…………………………………………………………………………………………….. ……………….
Table of contents………………………………………………………………………………………………..
List of Tables…………………………………………………………………………………………………….
List of Figures…………………………………………………………………………………………………..
List of Appendices……………………………………………………………………………………………….
List of Abbreviation…………………………………………………………………………………………….
Chapter 1: Introduction
1.0 General Introduction……………………………………………………………………………………..
1.1 Justification……………………………………………………………………………………………………
1.2 Aims and Objectives………………………………………………………………………………………..
Chapter 2: Literature Review
2.1.0 Significance of Pulmonary Function Test……………………………………………………….
2.1.1 Pulmonary Function Tests…………………………………………………………………………….
2.1.2 Pulmonary Mechanic Measurements……………………………………………………………….
2.1.3 Predicted Normal Values for Pulmonary Function………………………… ……………….
2.1.4 Chronic Obstructive Pulmonary Disease……………………………………………………….
2.2.0 Normal Arterial Blood Pressure………………………………………………….. ………………
2.2.1 Factors Determining Blood Pressure…………………………………………………………….
2.2.2 Viscosity of Blood…………………………………………………………………….. ………………..
2.2.3 Cardiovascular Regulatory Mechanisms……………………………………………………….
2.2.4 Blood Pressure………………………………………………………………………………………….
2.2.5 Blood…………………………………………………………………… …………………………………..
2.3.0 Wood Smoke………………………………………………………………………………………………
8
2.3.1 Carbon Monoxide……………………………………………………………………………………..
2.3.2 Oxides of Nitrogen and Sulfur………………………………………………………………………
2.3.3 Particulate Particles……………………………………………………………………………………..
2.3.4 Effect of wood smoke and Passive smoking (Secondary) on lung function and
COPD…………………………………………………………………………………………
2.3.5 Woodsmoke and Carcinoganic Substances…………………………………………………..
2.3.6 Blood…………………………………………………………………………………… ………………….
Chapter 3 Materials and Methods
3.1 Materials…………………………………………………………………………………………………..
3.2 Methods………………………………………………………………………………53
3.2
Statistical”Analysis…………………………………………………………………….. …………………..59
Chapter 4 Results
4.0 Results……………………………………………………………………………………. …………………….60
4.1 Arthropometric Parameters………………………………………………………………………………61
4.2 Cardiovascular (CVS) Parameters…………………………………………………………………….66
4.3 Haematological
Parameters………………….n…………………………………………………………70
4.4 Respiratory Function Test Parameters……………………………………………………………….73
Chapter 5:
Discussion……………………………………………………………………………………………………..77-81
Chapter 6:
Conclusion/Recommendation……………….n…………………………………………..82
References……………………………………………………………………………………………………..83-88
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LIST OF TABLES
Table 1: The mean + SEM, Percentage changes Z-test and`P value of age, weight,
height and BMI of women$that do not use wood to cook (control) ( group
1) and women that use wood to cook (group 2), study
group………………………………………………………n…………………………6
1
Table II: The mean + SEM, Percentage changes Z-test and P-value of pulse rate,
systolic, diastolic and mean arterial blood pressure of women that do not
use wood to cook control group (control group 1) and women that use
wood to cook study (group
2)………………………………………………………………………………………………
Teble III: The mean+ SEM, Percentage changes monocytes, eosinophils,
haemoglobin concentration (hb. Conc.) packed`cell volume (PVG) of
women that do not use wood to cook control group (group 1) and women
that use wood to cook study group (group
2)………………………………………………………………………………………………..
Table IV: The mean + SEM, Percentage changes, Z -test and P value of predicted
peak expiratory flow rate (PPEFR), Actual peak expiratory flow rate
(APEFR), forced expiratory volume 1 second percentage ratio (FEV1%)
of women that do not use wood to cook control group (group 1) and
women that use wood to cook study group (group
……………………………………………………………………………………………..
10
LIST OF FIGURES
Fig 1: Barchart showing mean+ SEM of age of control (not wood) and study group
(woodsmoke subjects…………………………………………………………………………………62
Fig 2: Barchart showing mean + SEM of weight of control (not wood) and study group
(wood smoke) subjects……………………………………………………………………………….63
Fig 3: Barchart showing mean + SEM of height of control (not wood) and study group
(wood smoke) subjects……………………………………………………………………………….64
Fig 4: Barchart showing mean + SEM of BMI of control (not wood) and study group
(wood smoke) subjects……………………………………………………………………………….65
Fig 5: Barchart showing mean + SEM of pulse rate of control (not wood) and study
group (wood smoke) subjects…………………………………………… ………………………..67
Fig 6: Barchart showing mean + SEM of blood pressure and mean arterial blood
pressure of control (not wood) and study group (wood smoke) subjects…………..68
Fig 7: Barchart showing mean + SEM of neutrophils lymphocytes, monocytes and
eosinophils of control (not wood) and study group (wood smoke) subjects………71
Fig 8: Barchart showing mean + SEM of Hb concentration of control (not wood) and
study group (wood smoke) subjects……………………………………………………………..72
Fig 9: Barchart showing mean + SEM of predicted and actual PEFR of control (not
wood) and study group (wood smoke) subjects……………………………………………..75
Fig 10: Barchart showing mean + SEM of FEV1% and PVC of control (not wood and
study group (wood smoke) subjects……………………………………………………………..76
Fig. 11: Barchart showing mean+ SEM of mean arterial blood pressure of control and
study group subjects…………………………………………………………………………………..69
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LIST OF APPENDICES
Appendix I
Questionnaire………………………………………………………………………………………………………89
Appendix II Data I (Woodsmoke users)………………………………………… ……………………….90
Appendix III Data II (Non Woodsmoke users)…………………………………………………………92
Appendix IV Ethnical Committee Clearance………………………………………… ………………..93
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LIST OF ABBREAVIATIONS
(1) ALRI – Acute lower respiratory illness
(2) ARI – Acute Respiratory Infection
(3) COPD – Chronic Obstructive Pulmonary disease
(4) FVC – Forced Vital Capacity
(5) TET – Total Expiratory Time
(6) SVC – Slow Vital Capacity
(7) FEVT – Forced Expiratory Volume Timed
(8) FEV1%- Forced Expiratory Volume in 1 second percentage
(9) PEFR – Peak Expiratory Flow Rate
(10) BSA – Body surface area
(11) RV – Residual Volume
(12) FRC – Forced residual capacity
(13) TLC – Total Lung Capacity
(14) GOLD – Global Initiative for Chronic Obstructive Lung Disease
(15) ABP – Arterial Blood Pressure
(16) SBP – Systolic blood Pressure
(17) PP – Pulse Pressure
(18) DBP – Diastolic Blood Pressure
(19) MABP – Mean Arterial Blood Pressure
(20) WBC – White Blood Cells
(21) RBC – Red Blood Cells
(22) PAH – Polycyclic Aromatic Hydrocarbons
(23) CO – Carbon Monoxide
(24) COHb – Carboxyhaemoglobin
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(25) DNA – Deoxyribonucleic Acid
(26) NO2 – Nitrogen dioxide
(27) AM – Alveolar Macrophage
(28) SPM – Suspended Particulate Matter
(29) CAPS – Concentrate air Particles
(30) COM – Coefficient of Haze
(31) ER – Emergency Room
(32) COA – Chronic airway obstruction
(33) PCs – Pulmonary C fibers
(34) DMTU – Dimetrylthiourea
(35) SIAHR- Smoke-induced airway hyper responsiveness
(36) PPEFR- Predicted Peak Expiratory Flow Rate
(37) OAD – Obstructive Airways Disease
(38) LPG – liquid Petroleum gas
(39) LNG – Liquefied Natural gas
(40) EAP – Environmental Protection Agency
(41) PCV – Packed Cell Volume
(42) ESR – Erythrocyte Sedimentation Rate
(43) CVS – Cardiovascular System
(44) BMI – Basal Metabolic Index
(45) APEFR- Actual Peak Expiratory Flow Rate
CHAPTER 1
INTRODUCTION
1.0 General Introduction The smell of wood smoke evokes fond memories for many people, but for others it has become a danger signal (Ammann, 1986). Wood crop residues and animal dung (biomass) is used by approximately half of the world‟s population as cooking and /or heating fuel. These fuels are handled and combusted primarily by women, who are largely responsible for chores such as cooking and are often involved in any household industries which involve cooking such as food processing (Aristanti, 1996).
When we first think of negative health effects connected to biomass fuel use, we invariably think of smoke. Indeed smoke is a health problem, but is not only because biomass is being used, it is also due to the stoves used to combust it and often poorly ventilated environment where the combustion takes place.
(Aristanti,1996).
The use of wood stove has increased greatly in the past decade, causing concern in many communities about the health effect of wood smoke. Wood smoke is known to contain such compounds as carbon monoxide, nitrogen oxides, sulfur oxides, aldehydes, polycyclic aromatic hydrocarbons and fine respirable particulate matters. All of these have been shown to cause deleterious physiologic responses in laboratory studies in humans. Some compounds found in woodsmoke include; benso (a) pyrene and formaldehyde are possible human carcinogens. Fine 15 particulate matter has been associated with decreased pulmonary function in children and with increased chronic lung disease in Nepal, where exposure to very high amounts of woodsmoke occurs in residences (Pierson et al, 1989).
The particles in woodsmoke are too small to be filtered by the nose and upper respiratory system so they wind up deep in the lungs. They can remain there for months causing structural damage and chemical changes.
Poisonous and cancer causing chemicals often enter the lungs by adhering to tiny particulate matter (Ammann, 1986).
Woodsmoke exposure causes decrease in lung functions and increase in secondary existing lung disease (which increases in smoke concentration or exposure time) (Ammann,1986). It also aggravates heart problems, the occurrence of respiratory illness in children has been shown to increase with predisposition and exposure to woodsmoke (Lewis, 1988). Acute lower respiratory illness (ALRI) has also been associated with exposure to domestic smoke, while cooking with wood burning stoves was associated with higher indoor air concentration of respiratory particles and with an increased risk of ALRI in Navajo children (Robin et al 1996).
Woodsmoke aggravates bronchitis, bronchial asthma, emphysema and pneumonia. Long term exposure may lead to emphysema, chronic bronchitis, arteriosclerosis, nasal, throat, lung, blood and lymph tissue cancers (based on animal studies) (Ammann, 1986).
16 Acute Respiratory Infection (ARI) is one of the top killer of children in developing countries, about five million deaths/year. In many developing communities, it is the primary cause of infant death. (Aristanti,1996). Women are more biologically sensitive to carbon monoxide (CO) emissions, during pregnancy, excessive or prolonged exposure represents an even more significant hazard. Carbon monoxide interference with the oxygen carrying capacity of the blood contributes to increased rates of low birth weight or still births.
(Smith,1996).
Chronic obstructive lung disease in adults, for which tobacco smoking is now the major risk factor in the developed countries, is known to result from excessive exposure to air pollution. Several studies have shown that non-smoking women who have cooked on biomass stoves for many years exhibit a higher prevalence of decreased lung volume and capacities and other chest diseases than women who have had less contact with biomass stoves. Indeed in an area of rural Nepal, nearly 15% of non-smoking women had chronic bronchitis , a high rate for non-smokers. Right-side heart failure has been found to be prevalent and to develop earlier than average in non-smoking women who cook with biomass in India and Nepal (Pandey, 1989).
As a result of the possible health hazards associated with smoke, it is surprising that there are few documented effects of woodsmoke on respiratory functions and haematological indices in Africa especially in Nigeria.
17 1.1 Justification The precise correlation between the use of Biomass fuels and health consequences has rarely been pinpointed. This is due to large numbers of confounding factors and the modest resources available for such research (Broakman, 1996).
There are some evidence to suggest that exposure to indoor pollutants like tobacco smoke may increase morbidity from chronic obstructive pulmonary disease (COPD). However, no study has clearly demonstrated a similar relationship between “COPD” and exposure to various cooking fuels (biomass) (Behera,1995).
In door air pollution due to the burning of biomass fuels has been shown to be an important factor increasing the prevalence of acute respiratory infections in children, and chronic obstructive pulmonary disease (COPD) often leading to heart failure in adult women (Nathan,1996).
The total human exposure to pollutants is much more substantial in the homes of the poor in developing countries than in the outdoor air of the cities in the developed world, which has received the vast majority of attention in the form of air pollution research and control efforts (Aristanti,1996).
As a result, this study becomes very relevant since there are practically very few studies on the effects of woodsmoke on both pulmonary functions and haematological indices in Africa and especially in Nigeria (Peters et al, 1999).
18 1.2 Aims and Objectives The aims of this research project was to investigate the effect of Biomass (with emphasis on wood smoke and crop residues) on some respiratory function and haematological variables by measuring ventilatory lung functions and haemotological indices amongst (1) women exposed to wood smoke and (2) those that were not exposed.
The objectives of this work were to find out if there were any differences between these two groups for: A) Lung function tests such as (i) Predicted Peak Expiratory Flow Rate (PPEFR) (ii) Actual Peak Expiratory Flow Rate (APEFR) (iii) Forced Vital Capacity (FVC) (iv) Forced Expiratory Volume in 1 second (FEV1 ) (v) Forced Expiratory Volume Ratio % (FEV1/FVC x 100) B) Cardiovascular Parameters such as i) Pulse rate ii) Systolic Blood Pressure iii) Diastolic Blood Pressure iv) Mean Arterial Blood Pressure C) Haematological Indices i) Hemoglobin Concentration (Hb Conc.) ii) Haematocrit Value/Packed Cell Volume (PCV) 19 iii) Differential Leucocyte Count D) Anthropometric Indices such as i) Age in years ii) Weight in kilogram iii) Height in meters iv) Body Mass Index (BMI) = weight (kg)/Height (m2) was calculated.
These parameters were all measured and presented in tables.
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