CleanAirSIG e-conference:

16 - 27 July 2007

“Taking ACTION to rid the world of Indoor Air Pollution”

Status: Draft

Study on Indoor Air Pollution/Bangladesh

Ms Tabassum Dana

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Biomass

Charcoal/ coal

Study on Indoor Air Pollution/Bangladesh Ms Tabassum Dana – World Health Organization, Dhaka The total population of Bangladesh is about 123 million. 94 million people live in the rural area and some 29 million people live in cities. Many live in slums, as in the 1125 different slums of Dhaka City (AKM Ahsan Ullah et al. 1999). Although the country is agro based it has the lowest per capita cultivable land, which forces rural people to migrate to the urban centres. Poverty is a world of darkness where every day is a struggle to survive, 45% of the population of the country fall below the poverty line and about 20% of population fall below the hard-core poverty line. The problem of poverty is affecting well over half the people in the urban areas of the country (BBS 2002)

Energy The energy resources of the country are not uniformly distributed all over the country. Mass population of the country re resided in rural areas where adequate attention has not been given to meet the energy demand of the rural people. The rural people meet their energy demand through the traditional biomass fuel. In Bangladesh a major portion of total energy is consumed in the domestic sector for cooking and lighting. In urban slum and urban fringe area for cooking energy is met through biomass fuel. 20-30% of the total organic energy is met by fuel wood remaining 70-80% is met from agricultural residues, cow dung, and wood scraps and wood dust. The following pyramid 2.1 shows the energy ladder that’s being used through out the country and this also indicates the most polluting energy to least polluting energy.

Fig: Energy Ladder: Commonly used though out the country & most polluting energy to least polluting energy.

Kerosene stove

Biogas/Improved stove

Gas Cylinder

Gas

Electricity

Dung, Crop Residue, Wood, & Wood Dust are largely used.

Most Polluting Energy

Least Polluting Energy

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Different Types of Biomass fuel

These types of fuel are being used in rural area and some

being practiced in urban areas

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The poorer of the country suffer most due to energy scarcity. According to Bangladesh Bureau of Statistics (BBS) report the low-income household spends more time, effort and of their income to meet their energy needs. In places where people have access to piped natural gas, LPG and electricity are mainly located in the urban areas. In some places it has been also observed that due to high price of LPG some are using fuel wood burning stove, in urban slum areas women are burning all sorts of stuff apart like synthetic materials, papers along with biomass fuel. The women in rural areas are in the forefront of the management of domestic energy. In rural area women spend a considerable amount of time gathering cooking fuels from surrounding areas, agricultural field and so forth. The biomass fuel and burning of synthetic product is harmful for their health, which highly pollutes product of the kitchen environment due to incomplete combustion of biomass fuels and causing damage to the respiratory system. In the following table shows the effects of burning of biomass fuels inside the kitchen generates many polluting gases causing harm to women engaged in cooking. Indoor Air Pollutants from Typical Wood Currently Used in Asia, in comparison with WHO Standards

Pollutants

Mechanisms of health effects Level of Pollutants (mg/m³)

WHO Standards (mg/m³)

CO Inhalation into respiratory system Absorption into blood from lungs Elevated carboxyhyemoglobin HbCO)

levels Reduced oxygen to body tissues Possible cilia-static impact on lung

clearance

150 10

Particulates Inhalation into respiratory system Deposition in respiratory tract Irritation and toxicity

3.3 0.1

Benzene Benzo (a) pyrene Inhalation into respiratory system Deposition and absorption in lungs Metabolic activation Precursor to cancer

0.8 0.002

Formaldehyde Irritation on mucosa Toxicity to cilia Reduction in lung clearance ability Possible carcinogen

0.7 0.1

Source: K.R. Smith, “Bio fuels, Air Pollutant and Health-A Global Review, “1987 and J. Koppejan, “Report of Expert Meeting on Emission Reduction of Wood Stove in South and South East Asia,” Wood Energy News Vol. 14 No 3, December 1999. It has been found in some places people are using electricity for cooking. Electricity for cooking purposes is also used in some rural areas as well where electricity is available but not in large scale it’s being practiced in this country. Mostly in government owned building, hostel staff quarter or in refugee camp area where electric bill is paid by the government body use electric stove.

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Biogas is another resource of energy used by some family members. Those who have access to poultry firm they are mainly using the biogas plant. The whole project of biogas plant is very new in thing for country and all can’t afford, as the socio-economic condition for majority of the population is not very solvent. Only people in rural area having access to cattle, poultry firm and economically stable can have access to biogas plant.

Indoor Air Pollution The indoor air pollution is one of the most critical environmental problems. Pollution is high in rural area as well in the urban slum area. In developing countries women and children are exposed to Suspended Particulate Matter and other particulate matter present in smoke. The urban ambient air pollution in developing countries is in the hundreds of g/m³ but indoor air, where biomass fuels, or coal, are being burned for cooking and heating, may have concentrations of particulate matter as high as thousands of g/m³. The combustion of biomass produces different types of chemical compounds including suspended particulate matter etc. Women and children living in urban slums are exposed to both indoor air pollution as well as outdoor air pollution. Women in rural areas are mainly exposed to indoor air pollution. The stove that they are using are one burner stove, low cost and converting energy at 12-18% efficiency rate, producing high levels of pollution. The smoke remains inside their kitchen room or in their living room, as they don’t have improved stove system or proper ventilation to let the smoke go out. Inhalation of smoke has great impact on health as they are exposed to carcinogen and carbon monoxide causing like upper respiratory diseases and lung cancer. In slum areas they don’t have separate place for cooking so they cook in open place and beside their living room. The children are sleeping, having food or playing in the same living area. Housing is part of environment and it is to some extent indicates responsibilities for ensuring man’s health and well being. In Dhaka’s slum, more than 6-8 persons are living in a single dwelling, which is overcrowding the single room. Over crowding is a great risk to health as it may spread respiratory diseases, ARI, infections like tuberculosis, influenza, cough, skin diseases, jaundice, diphtheria and many more.

Health Consequences from Indoor Air Pollution Indoor Air Pollution from cooking heating, lighting, tobacco smoke and burning mosquito coil have enormous impact on human health. Respiratory diseases cover a whole range of chronic and acute illness of the nose, ear, throat and lungs for example influenza, pneumonia, tuberculosis, bronchitis asthma and lung cancer. The overall issue of indoor air pollution has been neglected due to global interest in and technical capability to monitor industrial and vehicular pollution, which has instead focused on systematic ambient air monitoring. In developing countries it is estimated that human exposure to indoor air pollution in rural areas to be sixty times higher than in urban areas of developed countries and overall daily exposures about 20 times greater1. 1 James A. Listorti & Fadi M. Doumani ED Environmental Health Bridging the Gaps World Bank Discussion Paper No. 422

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The urban ambient air pollution in developing countries is in the hundreds of g/m³ but indoor air, where biomass fuels, or coal, are being burned for cooking and heating, may have concentrations of particulate matter as high as thousands of g/m³. Such high levels are especially alarming given that health effects may be shown at less than 100 µg/m³2. The following table 3.1 shows the particulate concentration in indoor and ambient air of urban and rural areas of developed and developing countries and also view the population exposures.

Particulate Concentrations and Population Exposures

AVERAGE CONCENTRATIONS EXPOSURES (%) GLOBAL TOTAL Region Indoor µg/m³ Ambient

µg/m³ Indoor % Ambient % Total %

100 70 7 1 8

Developed Urban Rural 80 40 2 0 2

250 280 25 9 34

Developing Urban Rural 400 70 52 5 57

Total 86 15 100 Source: Health and environment in sustainable development. Five years after the Earth Summit, 1997, WHO

Air Pollution Related Respiratory Illness

Pollution Types Main Sources

Indoor Cooking, heating, lighting fumes and dust. Tobacco smoke Important as predisposing or exacerbating factor, because contains

concentrations of many indoor and outdoor pollutants.

Major Components of Air Pollution

Pollutant Main Source Particulate Matter Essential Refers to suspended matter small enough to penetrate the lungs.

Includes anything that produces dust or smoke. (SPM, PM10) Carbon Monoxide Primarily from transport sector, household emission from cooking, heating

and tobacco smoke. Sulfur Oxides Combustion of coal, petroleum, wood. Major components of Tobacco

Smoke Nitrogen Oxides Combustion of coal, oil, natural gas and motor vehicle fuels. Biomass fuels

especially important for indoor air pollution. Tobacco smoke. Other smoke and fumes

Fossil fuels, such as coal, oil, kerosene and other natural gas; biomass fuels and natural gas, biomass fuels, such as wood, charcoal, dung, biogas.

2 Bendahemane B. D. (Rapporteur); Environmental Health Project Activity Report No. 38 Air Pollution and Child Health: Priorities for Action, 1997

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3.2 People At Risk Young children are affected due to number of reasons:

1. Most of children spend long periods of time in polluted environments with their mother.

2. The immune systems of the children are not developed and their small airways may be more vulnerable to the affects of inflammation.

3. Adult women are at risk of chronic conditions resulting from frequent and long periods of exposure to polluted environment during cooking.

The biomass contain immense amount of pollutants varying concentration levels, pose risk to human health. Out of hundreds of harmful pollutants and irritant gas some are more dangerous that include SPM, Carbon monoxide, nitrogen dioxide, sulphur dioxide, formaldehyde, and carcinogens such as benzo[a]pyrene and benzene, Hydro Carbons. Exposure to IAP smoke increases the risk of range of common and serious diseases to both women and children. It has been found that children under five years of age exposed to indoor air pollution from solid fuel use to have two to three times greater risk of developing lower respiratory infections compared to unexposed children. The following diagram links with health and IAP. ALRI is high in case of under 5 children and lead to death, COPD high among women these two diseases are chief among all other diseases.

Exposure to IAP

COPD

Lung Cancer

URI

Tuberculosis

Low Birth Weight

Eye Irritation & Cataract

ALRI ARI

Fig 3.2: Shows the link between Health & IAP

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The following table shows the relative risk estimates for health associated with exposure to smoke from household fuel.

Health Effects of Exposure to Smoke from Solid fuel Use: Plausible Ranges of Relative Risk in Households Using Solid Fuels Households

Health Outcome Population Affected Relative Risk Low High

Evidence

Acute Lower Respiratory Infections (ALRI)

< 5 years 2.0 3.0 Strong

Asthma Females > 15 years 1.4 2.5 Intermediate/moderate Blindness (cataracts) Females > 15 years 1.3 1.6 Intermediate/moderate

COPD Females > 15 years 2.0 4.0 Strong Lung Cancer Females > 15 years 3.0 5.0 Strong Tuberculosis Females > 15 years 1.5 3.0 Intermediate/moderate

Source: The above table is adapted from Smith KR and Mehta S. 2000. “The Burden of disease from indoor air pollution in developing countries. Comparison of estimates”, Paper presented at the USAID/WHO global Technical Consultation on the Health Impacts of Indoor Air Pollution and Household Energy in Developing countries.

General View for Bangladesh

Indoor air pollution is one of the most critical environmental problems, which is mainly among the lower income group or in the urban poor settlements. Indoor air pollution is due to inhalation of smoke coming from combustion of biomass products. The combustion of biomass produces different types of chemical compounds including suspended particulate matter etc. The smoke stays inside, as they don’t have improved stove system to let the smoke go out or proper ventilation. The inhalations of the smoke have great impact on the health. The children under five are the victims of indoor air pollution. They are exposures to carcinogen and carbon monoxide when they heat the room. In urban settlements when 6 or more people share one room to sleep cause-breathing problems as the room has no ventilation where the air can’t circulate. The children are suffocated as they can’t breath fresh air and less oxygen is circulated. In the slums air indoor air pollution is very high and the communicable diseases can be spread very easily. In rural houses are such way built that same way At national level the percentage of persons suffering from air pollution associated diseases, as reported to government hospitals are:

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Diseases Age Wise Diseases < 1 year 1-4 year 5-15 year 16+ year Total Acute Respiratory Inflammation

9.37% 6.34% 5.63% 5.88% 6.10%

Asthma 0.29% 1.12% 2.42% 2.80% 2.32% Eye Diseases 1.80% 2.49% 6.09% 4.40% 4.37% Source: Ministry of Health and Family Planning Welfare 1999; Health Bulletin 1997 In one of our study areas in the low-income, densely populated Mirpur area we have found that 34% of children are suffering from respiratory diseases, with 18% suffering from and cold and 16% from pneumonia. Percentage of Patients attending Outpatient Department suffering from ARI in the

Dhaka Shishu Hospital

WINTER (NOV.-FEB.) SUMMER (MAR.-JUN) MONSOON (JUL-OCT) YEAR ARI Wheeze ARI Wheeze ARI Wheeze

1996 39 21 35 10 25 8 1997 48 25 42 10 32 9 1998 52 33 45 15 35 11

Source: Feroz Ahmed (ED) 2000; Bangladesh Environment 2000 Published by BAPA From the above table it can be illustrated that on average 450 to 500 patients attended the out patients department including emergency room of Dhaka shishu hospital. According to the diseases patters of the out door patients department of Shishu hospital reveals that respiratory problem topped the list and from November to February 1998, 52 patients of the total 13025 patients have been suffering from ARI and 33 had wheeze who attended the out patients department of Dhaka Shishu Hospital. It can be noted that so far no analytical studies have been documented on indoor air pollution in our country, except for one small study done by Dr. Alauddin in collaboration with Child Hospital on this issue earlier this year. In view of the risks associated with indoor air pollution, WHO has taken up an initial study on indoor air pollution, in three locations, measuring SPM10 with air sampler. The locations are, two in urban slum areas in Dhaka city and one rural area in Gazipur.

Women & Children are exposed to smoke

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Sketch of Kitchen the types of households

The following types of kitchen are mainly used by rural and urban slum dwellers all over

the country.

INDOOR KITCHEN WITHOUT PARTITION

This type of kitchen was found in Cox’s Bazar non

gas area, in Mahmadpur Refugee Camp area. In

these room ventilation was not there only door is

used as ventilation purposes.

Kitchen

INDOOR KITCHEN WITH PARTITION

This type of kitchen was found in Cox’s Bazar non-

gas and gas area; also found in Mohammedpur

Gazipur area. In this kitchen room ventilation is

also missing. But in Mohammed kitchen room had

some sorts of ventilation.

Kitchen

Partition Stove

Stove

Window

Indoor Kitchen with window and without ventilation

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SEPARATE KITCHEN: OUTSIDE THE LIVING ROOM

This type of kitchen has been observed in

Gazipur, in Matalab, one or two houses in

Cox’s Bazar. In gas area there are ventilation

but in non-gas area no provision of

ventilation.

Stove kitchen

Outdoor Kitchen with one side open use during the wet season

Indoor Kitchen without any ventilation with partition

Indoor Kitchen with partition and ventilation

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Statement: The study of India reveals the difference of concentration of particulate matter due to

effect of kitchen configuration. There was no significant difference in concentrations of

particulate matter between household having indoor kitchens with partition and those

without partitions and concentrations ranges between 666 g/m³ to 652 g/m³.

Particulate matter concentration in Indoor kitchens are much more higher that outdoor

kitchens, which ranges between 659 g/m³ to 436 g/m³. All level are well above the

health guidelines for outdoor air quality.

Concentration is always high in household having kitchen without partitions 559 g/m³

compare to kitchen with partition 357 g/m³ and separate kitchen outside the

concentration ranges 280 g/m³ is much high than compared to kitchen absolutely

outdoor open 215 g/m³.

In our country this types of analysis has not been carried out

but only one study has been done measuring the SPM10 where

kitchen was located into three site and concentration ranges

between 4000-5000 g/m³ compare to 70 g/m³ of WHO

standard. The test was done only for one hour during cooking

and could vary if the test was done on 24-hour basis. The study

that was conducted in urban slum area and in Gazipur where

the kitchen condition was as same as this survey shows and

Outdoor Kitchen during the dry season in urban peripheral area and rural area

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both in urban and in rural area similar types of fuel are being used the previous survey of

WHO study result are shown in the following table.

Kitchen Condition Fuel used

SPM (g/m³

air)

SPM (g/m³

air)

SPM (g/m³

air) 5091 10102 4445 4545 5253 10910 5253 39192

4440

4040 4442 18586

1. Four side close, one side open. Located 10 feet away from the living room.

2. Kitchen totally blocked on 3 sides by bedrooms and sealed fence causing whirling

wind to spread smoke in the house premises.

3. All side close only open in the roof side. Stove is placed beside their living room.

Smoke is trapped in the lane and inside their living room. Very poor Ventilation.

Paper, dry leaves, wood

shaving, paddy straw and

wood scraps dry leaves,

Crop residues cardboard,

coconut shell wood dust,

8485 9455

If test could be conducted in all four areas to measure indoor air pollution then results could be similar or could be closer.