Investigation of Ocular Disease and Household Fuel Use in Kaski District, Nepal

 描述(申请人提供)：全世界约有30亿人使用固体燃料(煤和生物质)做饭和取暖--几乎所有人都在发展中国家。煤油也被广泛用于烹饪和照明。这些燃料向厨房排放高浓度的污染物，包括颗粒物、一氧化碳和其他已知的影响眼睛的有机化合物，如甲醛和萘。通常情况下，做饭的女性是最容易受到感染的。有证据表明固体燃料与广泛的健康影响有关，但对眼病的影响还没有得到广泛的调查。几乎没有研究调查煤油的使用和眼部疾病。在世界各地，女性在各个年龄段患眼病的风险都更高。大约90%的视障和盲人生活在发展中国家。这两项密切相关的眼病研究侧重于晶状体白内障和老年性黄斑变性(AMD)，这是世界上第一和第三种最常见的致盲原因，以及干眼病，是疼痛和不适的主要原因。这两项研究利用了现有的基础设施，包括办公室、车辆和训练有素的现场工作人员，以及先前的数据收集--家庭烹饪、取暖和照明设备的使用，以及空气污染监测数据--这是由美国国立卫生研究院资助的早期在尼泊尔博卡拉进行的结核病和室内燃料使用的流行病学研究。眼病研究是一项调查白内障和干眼病的横断面研究，以及一项调查AMD的病例对照研究。在这项横断面研究中，来自结核病研究家庭的40-70岁的妇女将被运送到博卡拉的Manipal教学医院，在那里她们将接受免费的全面眼睛检查。这些妇女是根据她们的烹饪、供暖和照明设备的使用情况选择的。将拍摄水晶晶状体的裂隙灯照片，并进行干眼病测试。另外，将进行一项在住院妇女中诊断为AMD的病例对照研究。这两项研究的统计分析将侧重于检查家庭燃料使用、烹饪、取暖和照明与眼睛结果指标之间的关联。总而言之，这些将构成对这些潜在因果关系的有史以来最全面的调查。结果将对政策和卫生干预措施产生影响。特别是，如果有证据表明煤油是眼病的风险因素，那么这将加强不将煤油作为生物质的清洁燃料替代品的论点，这是包括世卫组织在内的一些国际机构目前的政策。这些研究将为用液化石油气炉具或电子照明等替代品取代生物质炉具和燃料型照明光源的返工成本效益分析提供数据。

 DESCRIPTION (provided by applicant): Solid fuels (coal and biomass) are used for cooking and heating by approximately 3 billion people worldwide-- almost all in the developing world. Kerosene is also widely used for cooking and lighting. These fuels emit into the kitchen high concentrations of pollutants, including particulate matter, carbon monoxide and other organic compounds known to affect the eye, such as formaldehyde and naphthalene. Usually, women doing the cooking are the most exposed. There is evidence linking solid fuels to a wide range of health effects, but the impact on eye diseases has not been extensively investigated. Virtually no studies have investigated kerosene use and eye disease. In every part of the world, females are at higher risk of eye disease at all ages. About 90% of visually impaired and blind people lived in developing countries. These two closely related ocular disease studies, which focus on cataract of the lens and age-related macular degeneration (AMD), the first and third most common causes of blindness in the world, and dry eye disease, a major cause of pain and discomfort, take advantage of the established infrastructure, including offices, vehicles and trained field staff, and prior data collection-household cooking, heating and lighting appliance use, and air pollution monitoring data--of an earlier NIH-funded epidemiologic study of TB and indoor fuel use, in Pokhara, Nepal. The ocular disease studies are a cross-sectional study investigating cataract and dry eye disease, and a case-control study investigating AMD. In the cross-sectional study, women, aged 40-70 years, from TB study households, chosen on the basis of their cooking, heating and lighting appliance use, will be transported to the Manipal Teaching Hospital in Pokhara, where they will receive a free and comprehensive eye examination. Slit-lamp photos of the crystalline lens will be taken and tests done for dry eye disease. Separately, a case-control study of AMD diagnosed in women attending the hospital will be carried out. Statistical analysis in both studies will focus on examining associations between household fuel uses, for cooking, heating and lighting, and the ocular outcome measures. Together, these will comprise the most comprehensive investigation ever of these potentially causal relationships. Results will have implications for policy and for health interventions. In particular, if evidence is produced that kerosene is a risk factor for eye diseas, then this will strengthen arguments for not treating kerosene as a clean fuel alternative to biomass, as is currently the policy of some international agencies, including WHO. The studies will provide data for reworking cost-benefit analyses of replacing biomass stoves and fuel-based lighting sources with alternatives, such as LPG stoves or electric lighting.