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

 说明（由申请人提供）：全世界约有30亿人-几乎都在发展中国家-使用固体燃料（煤和生物量）做饭和取暖。此外，它还广泛用于烹饪和照明。这些燃料会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会影响眼睛的有机化合物，如甲醛和萘。通常，做饭的女人是最暴露的。有证据表明，固体燃料与广泛的健康影响有关，但对眼疾的影响尚未得到广泛调查。事实上，没有研究调查煤油的使用和眼疾。在世界的每一个地方，女性在所有年龄段都有更高的患眼疾的风险。大约90%的视力受损者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透镜白内障和年龄相关性黄斑变性（AMD）（世界上第一和第三大最常见的致盲原因）以及干眼病（疼痛和不适的主要原因），它们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，以及事先收集的数据-家庭烹饪、取暖和照明器具的使用，和空气污染监测数据--这是早些时候在尼泊尔博卡拉由NIH资助的结核病和室内燃料使用流行病学研究的结果。眼部疾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。 在横断面研究中，根据烹饪、取暖和照明器具的使用情况，从结核病研究家庭中选择40-70岁的妇女，将被送往博卡拉的Manipal教学医院，在那里她们将接受免费和全面的眼科检查。将对晶体透镜进行裂隙灯拍照，并进行干眼病检查。 另外，将对就诊于医院的女性中诊断的AMD进行病例对照研究。这两项研究的统计分析将集中在检查家庭燃料使用，烹饪，取暖和照明，以及眼部结果的措施之间的关联。总之，这些将构成对这些潜在因果关系的最全面的调查。研究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疾的一个危险因素，那么这将加强不把煤油作为生物量的清洁燃料替代品的理由，而这正是包括世卫组织在内的一些国际机构目前的政策。这些研究将提供数据，用于重新进行成本效益分析，以替代品，如液化石油气炉灶或电灯取代生物量炉灶和燃料照明。

 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.