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Majid Ezzati^1,2 and Daniel M. Kammen³

¹Science, Technology, and Environmental Policy Program, Princeton University, Princeton, New Jersey, USA; ²Epidemiology and Burden of Disease Unit, World Health Organization, Geneva, Switzerland; ³Energy and Resources Group, University of California, Berkeley, California, USA

Abstract

Acute respiratory infections (ARI) are the leading cause of burden of disease worldwide and have been causally linked with exposure to pollutants from domestic biomass fuels in developing countries. We used longitudinal health data coupled with detailed monitoring and estimation of personal exposure from more than 2 years of field measurements in rural Kenya to estimate the exposure-response relationship for particulates < 10 µm diameter (PM₁₀) generated from biomass combustion. Acute respiratory infections and acute lower respiratory infections are concave, increasing functions of average daily exposure to PM₁₀, with the rate of increase declining for exposures above approximately 1,000-2,000 µg/m³. This first estimation of the exposure-response relationship for the high-exposure levels characteristic of developing countries has immediate and important consequences for international public health policies, energy and combustion research, and technology transfer efforts that affect more than 2 billion people worldwide. Key words: acute respiratory infections, Africa, biomass combustion, developing countries, exposure-response relationship, field study, indoor air pollution, particulate matter, public health. Environ Health Perspect 109:481-488 (2001) . [Online 4 May 2001]

http://ehpnet1.niehs.nih.gov/docs/2001/109p481-488ezzati/ abstract.html

Address correspondence to M. Ezzati, Global Programme on Evidence for Health Policy, World Health Organization, CH-1211 Geneva 27, Switzerland. Telephone: 41 22 791 2369. Fax: 41 22 791 4328. E-mail: ezzatim@who.ch

We thank S. Munyi, J. Murithi, the administration of Nanyuki District Hospital, and A.W. Muriithi (Kenyatta National Hospital and National ARI Programme) for their valuable help in design and execution of the health monitoring system. We thank B. Mbinda, M. Egelian, P. Ekuam, M. Lokeny, and J. Ngisirkale for valuable assistance in data collection and the residents of Mpala Ranch for their kind hospitality, which made data collection possible. The African Academy of Sciences provided institutional support in Kenya. N. Goldman, B.H. Singer, K.R. Smith, and three anonymous reviewers provided valuable comments on data analysis methodology and epidemiology of acute respiratory infections.

This research was supported by grants from Summit and Compton Foundations, Social Science Research Council, and the Princeton University Council on Regional Studies and Center of International Studies (through a grant from the MacArthur Foundation) . This research was approved by the Institutional Review Panel for Human Subjects of the University Research Board, Princeton University (Case #1890) and by the Government of Kenya, under the Office of the President Research Permit OP/13/001/25C 167. It has followed all the human subject guidelines, including consent of subjects to data collection. The findings and conclusions in this paper are those of the authors and do not reflect the views of the World Health Organization.

Received 2 October 2000 ; accepted 21 November 2000.