Assessment of Carbon Monoxide Exposure among Women Cooking With Biomass Fuels and Their Children Living in Sudan
Objective: Questionnaires were used to assess levels of household air pollution [HAP], defined as inhalation of smoke from biomass fuels. Women and their children in developing countries are at higher risk of HAP exposure due to the disproportionate time spent indoors exposed to smoke from biomass fuels used for cooking. HAP contains multiple substances including [CO], which attaches to red blood cells causing hypoxia. CO combined with other inhaled substances such as particulate matter 2.5 (PM2.5), can lead to poor respiratory health among the affected households. Monitoring of HAP has traditionally measured the [CO] exposure within the living environment; however exposure in dwellings may not accurately measure an individual’s exposure. This study demonstrates that CO, a major component of HAP, can be measured using a COoximeter and that subjects’ CO levels represent a biomarker and a surrogate for overall HAP exposure.
Methods: Women of low socioeconomic status and of reproductive age and their children were invited to six women’s centers in Port Sudan, Sudan. At a single visit, data on dwelling size, cooking fuels and health information were collected and CO levels of mothers and children were measured using the Masimo Rad-57 Rainbow Pulse CO-oximeter. Anthropomorphic measurements of children were made using standard equipment.
Results: Data were collected on 373 women, 100 were excluded due to inaccurate CO-oximetery readings. Headache, cough, weakness, dyspnea, fatigue, as well as lung infections and infants perceived to be small at birth were reported more often among women with higher CO levels. Four hundred thirty one children were enrolled and 87 excluded because the children or their mothers had invalid CO-oximetry or missing data. Mean CO levels were higher in all age groups among children exposed to biomass cooking fuels compared with gas. These levels were consistent with the maternal levels. Children with moderate [10-15%] and high CO levels [16-25%] had more symptoms associated with CO poisoning, more chest infections and were smaller at birth and smaller when compared to WHO standards.
Conclusion: CO-oximetry is a valuable tool to assess individuals exposed to high levels of HAP and the resulting CO levels are an important biomarker for these exposed individuals.