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Exposição ao uso da lenha para cocção no Brasil e sua relação com os agravos à saúde da população. Exposure to the use of wood for cooking in Brazil and its relation with the health problems of the population.
Abstract
A poluição do ar em ambientes fechados é agravada pela queima de lenha em fogões rústicos e ambientes pouco
ventilados. A exposição aos poluentes emitidos por este tipo de combustível resulta no aumento da morbidade e da mortalidade. No Brasil, os estudos e estimativas são escassos. Visando entender esta problemática, o objetivo deste trabalho foi investigar o uso de lenha utilizando as séries de dados das agências governamentais para estimar o número de pessoas expostas. Os resultados apontam que a lenha é o segundo combustível mais usado para cozinhar, sendo utilizada por uma parcela significativa da população, em torno de 30 milhões de brasileiros. Um fator decisivo no maior uso deste combustível é o nível socioeconômico da população associada ao preço do gás liquefeito de petróleo (GLP). Os estudos realizados no país registraram concentrações altas de partículas durante a queima da lenha, excedendo os limites sugeridos pela Organização Mundial da Saúde (OMS). Também foram observadas associações entre a exposição aos poluentes gerados pela queima e o agravamento dos mais diversos problemas de saúde, dentre eles doenças respiratórias e câncer. A substituição da lenha e outros combustíveis sólidos por combustíveis mais limpos deve ser a meta do governo para minimizar custos com a saúde.
RESUMO A lenha vem sendo substituída ao longo dos anos por novas formas de energia, como o gás liquefeito de petróleo (GLP) e a eletricidade. Porém, esse combustível ainda representa uma fração significativa da matriz energética brasileira, muito embora as pesquisas referentes ao seu uso ainda sejam limitadas e regionais. O objetivo deste estudo foi realizar um levantamento da produção, consumo e características da lenha usada com a finalidade de cocção. De acordo com os resultados, em 2016, 26,5% da lenha produzida no Brasil foram empregados com fins residenciais, ou seja, em torno de 2x107 toneladas. A lenha é proveniente tanto da silvicultura, sendo o Paraná o maior produtor, quanto do extrativismo, sendo a Bahia a maior produtora. O estado que apresenta maior dependência desse combustível para a cocção é o Pará, enquanto o Rio de Janeiro, praticamente, não a usa para esse fim. O consumo per capita varia muito de uma região a outra do país. Com base nos dados de 2016, foi estimado um consumo de 1,7 kg/pessoa/dia. No entanto, estudos in loco mostraram variação de 0,7 a 8,5 kg/pessoa/dia. O levantamento aponta que uma parte considerável da lenha é proveniente de matas nativas que têm reflexos no desmatamento de uma dada região. A pouca disponibilidade de dados e a variação entre eles impede uma avaliação mais precisa do uso deste combustível no país e suas implicações para a saúde das florestas. A implantação de políticas públicas deveria ser prioridade do governo, pois o uso da lenha de forma inadequada afeta o manejo da vegetação nativa, além de ser uma questão socioambiental, econômica e de saúde pública.
Este trabalho apresenta os resultados de um estudo realizado numa pequena comunidade rural denominada Engenho, localizada no município de São João D'Aliança, GO, onde foi analisado o consumo residencial de lenha para a cocção de alimentos. Para tanto, foram distribuídos feixes de lenha entre os moradores com o comprometimento de informar o tempo gasto para o consumo. Paralelamente foi feito um levantamento dos dados socioeconômicos da comunidade pela aplicação de um questionário, e a biomassa foi caracterizada. O consumo médio foi de 10,54 kg/domicílio ou 3.847 kg/domicílio/ano, o que correspondeu a 2,53 kg/adulto equivalente/dia. Estimou-se um consumo volumétrico anual de 256,53 st para toda a comunidade. A massa especifica básica média foi de 0,61 g/cm3, poder calorífico líquido médio de 2.898 kcal/kg. O consumo energético foi estimado em 30,55 Mcal/domicílio/dia ou 11.151,54 Mcal/domicílio/ano. Verificou-se correlação significativa entre o consumo de lenha e o número de adultos equivalente por domicílio.
Objetivou-se caracterizar o perfil do consumo de lenha e carvão vegetal nas residências urbanas de Lages/SC e identificar as características socioeconômicas que influenciam na quantidade consumida. Foram amostradas aleatoriamente 178 residências, por meio de um questionário estruturado. As informações coletadas proporcionaram quantificar o consumo de lenha e de carvão vegetal nas residências e caracterizar sua utilização e algumas características dos domicílios. Um conjunto de oito variáveis explicativas foram consideradas para avaliar a quantidade consumida de lenha ou carvão vegetal, separando as residências em dois grupos – as que consomem e as que não consomem. Os dados foram analisados utilizando-se estatística descritiva, correlação linear e análise de componentes principais (ACP). A lenha é consumida em 38,2% dos domicílios entrevistados, com quantidade predominante de 0,1 a 2 st/ano (780 kg/domicílio/ano), enquanto que 36% consomem carvão vegetal, predominantemente até 15 kg/mês (141,7 kg/domicílio/ano). A lenha é adquirida através de compra, preferencialmente em pedaços para uso em fogão ou lareira, tanto para cocção de alimentos como para aquecimento. As principais variáveis que estão associadas ao consumo de lenha foram a disponibilidade de fogão e lareira no domicílio e o número de pessoas, enquanto que para o carvão vegetal foi a produção de churrasco.
Large amounts of forest wood is still being used in rural housing in low and mid-income
countries in South America - 36% in Peru and 6% in Brazil - generating hazardous wood
smoke.
Interviews were conducted to the users of improved stoves in 20 rural households. In Peru,
the field study was carried out during the heating season. Real time concentrations of carbon
monoxide were measured using HOBO data loggers while fine particles concentrations were
measured in Brazil using a TSI Dust-track monitor before and during the stove operation.
The adoption of improved stoves is limited by women cooking habits, safety aspects and the
transition to LPG. CO concentrations never exceeded 60 mg/m3 (30 minutes) while increased PM2.5 concentrations exceeded 160 µg/m3 (1-hour) in 4 dwellings.
Indoor emissions from heating stoves were reported in closed rooms while outdoor-indoor
transport was the main source of fine particle in open kitchen balconies.
This study provides an approximation of the potential impact of fuelwood harvesting in one of the most threatened tropical biodiversity conservation hotspots, the northern portion of the Brazilian Atlantic Forest. We test the relationship between fuelwood consumption and per capita income for 270 households distributed over 7 rural settlements. In general 76% of the households use fuelwood regularly and consume on average 686 kg/person/year of tree biomass, poorer people, however, consume 961 kg/person/year. Harvesting is concentrated to a few early successional species. Yet, annual rural population demand from 210 municipalities may reach 303,793 tons, equivalent to 1.2 to 2.1 thousand hectares of tropical forest. Fuelwood harvesting cannot be ignored as a major and chronic source of forest degradation in highly fragmented and densely populated landscapes and conciliating biodiversity conservation with poverty amelioration is an urgent task.
OBJECTIVE: To study the prevalence of and major factors associated with recurrent wheezing in children younger than 13 years of age in the urban area of Rio Grande, in the state of Rio Grande do Sul, Brazil. METHODS: The presence of recurrent wheezing was investigated in a cohort as part of a cross-sectional study that was begun in 1997 that focused on the morbidity from respiratory diseases in children then between 0 and 5 years of age. During home visits in 2004 a standardized questionnaire given by trained interviewers was used to obtain information concerning the family's socioeconomic and living conditions, maternal care during pregnancy and delivery, and children's current and previous morbidity patterns. The statistical analysis included the calculation of the odds ratio (OR) and 95% confidence interval (95% CI), with nonconditional logistic regression adjustment for potential confounding factors, according to a predefined hierarchical model. RESULTS: Of the 775 children studied in 1997, 685 were located in 2004 (loss of 11.6%). In this group, the prevalence of recurrent wheezing at the time of the interview was 27.9%. After adjustment, the risk factors were: current rhinitis (OR = 45.7; 95% CI: 24.2 to 86.5), use of wood stove for cooking (OR = 2.7; 95% CI: 1.4 to 4.9), child's history of acute respiratory infection (OR = 2.1; 95% CI: 1.3 to 3.5), bottle feeding (OR = 2.1; 95% CI: 1.1 to 3.8), history of asthma in siblings (OR = 1.9; 95% CI: 1.2 to 3.2), maternal history of asthma (OR = 1.8; 95% CI: 1.1 to 2.9), and fewer than six prenatal medical consultations (OR = 1.6; 95% CI: 1.1 to 2.4). Paternal schooling
Background: Exposure to household air pollution from cooking with solid fuels in simple stoves is a major health risk. Modeling reliable estimates of solid fuel use is needed for monitoring trends and informing policy.
Objectives: In order to revise the disease burden attributed to household air pollution for the Global Burden of Disease 2010 project and for international reporting purposes, we estimated annual trends in the world population using solid fuels.
Methods: We developed a multilevel model based on national survey data on primary cooking fuel.
Results: The proportion of households relying mainly on solid fuels for cooking has decreased from 62% (95% CI: 58, 66%) to 41% (95% CI: 37, 44%) between 1980 and 2010. Yet because of population growth, the actual number of persons exposed has remained stable at around 2.8 billion during three decades. Solid fuel use is most prevalent in Africa and Southeast Asia where > 60% of households cook with solid fuels. In other regions, primary solid fuel use ranges from 46% in the Western Pacific, to 35% in the Eastern Mediterranean and < 20% in the Americas and Europe.
Conclusion: Multilevel modeling is a suitable technique for deriving reliable solid-fuel use estimates. Worldwide, the proportion of households cooking mainly with solid fuels is decreasing. The absolute number of persons using solid fuels, however, has remained steady globally and is increasing in some regions. Surveys require enhancement to better capture the health implications of new technologies and multiple fuel use.
Objective:
To identify and characterize alterations seen on HRCT scans in nonsmoking females with COPD due to wood smoke exposure.
Methods:
We evaluated 42 nonsmoking females diagnosed with wood smoke-related COPD and 31 nonsmoking controls with no history of wood smoke exposure or pulmonary disease. The participants completed a questionnaire regarding demographic data, symptoms, and environmental exposure. All of the participants underwent spirometry and HRCT of the chest. The COPD and control groups were adjusted for age (23 patients each).
Results:
Most of the patients in the study group were diagnosed with mild to moderate COPD (83.3%). The most common findings on HRCT scans in the COPD group were bronchial wall thickening, bronchiectasis, mosaic perfusion pattern, parenchymal bands, tree-in-bud pattern, and laminar atelectasis (p < 0.001 vs. the control group for all). The alterations were generally mild and not extensive. There was a positive association between bronchial wall thickening and hour-years of wood smoke exposure. Centrilobular emphysema was uncommon, and its occurrence did not differ between the groups (p = 0.232).
Conclusions:
Wood smoke exposure causes predominantly bronchial changes, which can be detected by HRCT, even in patients with mild COPD.
CONTEXT AND OBJECTIVES
Esophageal cancer is the eighth commonest type of cancer worldwide, occupying sixth place in terms of mortality. Smoking and alcohol use are known risk factors for this type of cancer. The aim here was to evaluate the risk factors for esophageal cancer in a low-incidence area.
DESIGN AND SETTING
Case-control study in Goiânia, with 99 cases of esophageal cancer and 223 controls.
METHODS
The variables were sociodemographic, dietary, occupational and lifestyle data. The sample was analyzed using the chi-square test, Mann-Whitney test and Mantel-Haenszel approach for multivariate analysis. Odds ratios (OR) were calculated with 5% significance and 95% confidence intervals.
RESULTS
The risk of esophageal cancer was higher in patients ≥ 55 years (OR = 1.95; P < 0.001). Patients from rural areas were at greater risk of esophageal cancer (OR = 4.9; P < 0.001). Smoking was a risk factor among the cases (OR = 3.8; P < 0.001), as was exposure to woodstoves (OR = 4.42; P < 0.001). The practice of oral sex was not a risk factor (OR = 0.45; P = 0.04). Consumption of apples, pears, vegetables, cruciferous vegetables and fruit juices were protective against esophageal cancer.
CONCLUSION
In a region in which the incidence of esophageal cancer is low, the most significant risk factors were exposure to woodstoves, smoking and living in rural areas.
Objective:
To assess risk factors associated with hospital admission due to acute lower respiratory tract infection (ALRTI) in indigenous Guarani children <5 years of age in southern Brazil.
Methods:
Population-based matched case-control study from May 2007 to June 2008 in 81 Guarani villages. Cases were defined as hospital admissions due to confirmed ALRTI. Two controls free from acute respiratory infection, matched according to age, sex and place of residence, were selected for each case at the time of the case's hospitalisation. Both cases and controls were recruited by a surveillance routine established for the study.
Results:
The analysis was performed on 120 cases and 201 controls. The risk factors that remained significantly associated with hospitalisation due to ALRTI in the hierarchical multivariate conditional logistic regression were: low stable monthly per capita household income (<US$30.00 = OR: 2.77, IC95% : 1.51-5.10; no income= OR: 1.88, IC95% : 1.02-3.47); large number of persons in the household (6-9 = OR: 2.03, IC95% : 1.06-3.88; 10-16 = OR: 5.00, IC95% : 1.81-13.86); indoor exposure to fumes from burning firewood used for cooking (OR: 3.08, IC95% : 1.39-6.84);low maternal age (OR: 2.77, IC95% : 1.42-5.39); and low birthweight (OR: 6.12, IC95% : 1.44-26.13).
Conclusion:
Acute respiratory infections are a major cause of morbidity and mortality among Guarani children. Our study provides the first evidence about their determinants in indigenous peoples in Brazil that can help to better understand the epidemiology of respiratory infections in indigenous children.
To investigate the relationship between exposure to a landfill site closed 6 years previously and respiratory symptoms in children aged up to 13 years.
This was a cross-sectional study conducted in Várzea Paulista, in the state of São Paulo, Brazil. One adult in every household in a neighborhood close to the landfill and from a randomized sample of households in another neighborhood with similar socioeconomic characteristics but no landfill were interviewed and asked about respiratory symptoms and other variables relating to children aged up to 13. A logistic regression model was used to study this relationship.
The likelihood of a child having respiratory symptoms was a function of -2.36 + 0.43 if the child was less than 2 years old; + 0.24 if the child lived in the landfill area; -0.67 if there was a computer at home; + 0.54 if firewood was burnt in the home in the last year; + 0.94 if the child was diagnosed with asthma; + 0.87 if the child visited a health service in the previous 30 days.
The authors conclude that living near to a landfill closed 6 years previously may be a risk factor for respiratory disease in children.
Incidence rates for cancers of the upper aero-digestive tract in Southern Brazil are among the highest in the world. A case-control study was designed to identify the main risk factors for carcinomas of mouth, pharynx, and larynx in the region. We tested the hypothesis of whether use of wood stoves is associated with these cancers.
Information on known and potential risk factors was obtained from interviews with 784 cases and 1568 non-cancer controls. We estimated the effect of use of wood stove by conditional logistic regression, with adjustment for smoking, alcohol consumption and for other sociodemographic and dietary variables chosen as empirical confounders based on a change-in-estimate criterion.
After extensive adjustment for all the empirical confounders the odds ratio (OR) for all upper aero-digestive tract cancers was 2.68 (95% confidence interval [CI] : 2.2-3.3). Increased risks were also seen in site-specific analyses for mouth (OR = 2.73; 95% CI: 1.8-4.2), pharyngeal (OR = 3.82; 95% CI: 2.0-7.4), and laryngeal carcinomas (OR = 2.34; 95% CI: 1.2-4.7). Significant risk elevations remained for each of the three anatomic sites and for all sites combined even after we purposefully biased the analyses towards the null hypothesis by adjusting the effect of wood stove use only for positive empirical confounders.
The association of use of wood stoves with cancers of the upper aero-digestive tract is genuine and unlikely to result from insufficient control of confounding. Due to its high prevalence, use of wood stoves may be linked to as many as 30% of all cancers occurring in the region.
One of the main methods of extracting vegetation from the Caatinga is the cutting of wood for firewood. However, despite its social importance and its capacity for having environmental impacts, there are no studies that evaluate the dynamics of the collection of this resource in relation to temporal factors in the semi-arid regions of Brazil. Thus, the main purpose of this study was to show that the seasonality of the savanna climate might influence local patterns of collecting firewood. Between December 2008 and February 2010, interviews and eleven in situ inventories were performed in the residences of two rural communities in the municipality of Soledad in the state of Paraíba (Northeast Brazil). During the in situ inventories, all stocks were measured (m³), and species diversity was recorded. A total of 22 species were cataloged, but the pressure of collection was not distributed across all plants; there was a small group of species that were collected throughout the year, and these were found more frequently and with greater abundance in the residences. Although species richness was not influenced by seasonality, the volume of wood varied significantly between the dry and rainy seasons. More collections are performed in the dry season, and the local vegetation suffers greater extraction pressure from this use. The results obtained reinforce the need for studies that examine the potential for regrowth, plant productivity after selective cutting and the resting time necessary before performing a new cutting cycle, as this is the only way to better understand the implications regarding the use of firewood and its effects on local conservation.
This review examines developing-country air pollution from the standpoint of a useful analysis technique that has been under development in recent years: "total exposure assessment'. The review is composed of four parts: a brief description of the historical and current relationship between energy use and air pollution; an explanation of the idea of exposure assessment and the power that it can bring to analyses of the health impacts of air pollution; focusing on developing countries, a global exposure assessment; and a review of the health effects literature relevant to the micro-environments found to harbor the largest human exposures. -from Author
Acute respiratory infections (ARI) are the leading cause of the 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 of personal exposure from more than two years of field measurements in rural Kenya to examine the reductions in disease from a range of interventions, including changes in energy technology (stove or fuel) and cooking location. Our estimates show that the suite of interventions considered here, on average reduce the fraction of times that infants and children below 5 yr are diagnosed with disease by 24–64% for ARI and 21–44% for acute lower respiratory infections (ALRI). The range of reductions is larger for those above 5 yr, and is highly dependent on the time-activity budget of individuals. These reductions due to environmental management in infant and child ALRI are of similar magnitude to those achieved by medical interventions.
We studied exposure to solid fuel and second-hand tobacco smoke among pregnant women in south Asia, Africa and Latin America.
Prospective cross-sectional survey.
Antenatal clinics in Argentina, Brazil, Ecuador, Guatemala, Uruguay, Democratic Republic of Congo, Zambia, India and Pakistan.
A total of 7,961 pregnant women in ten sites in nine countries were interviewed between October 2004 and September 2005.
A standardized questionnaire on exposure to indoor air pollution (IAP) and second-hand smoke was administered to pregnant women during antenatal care.
Exposure to IAP and second-hand tobacco smoke.
South Asian pregnant women commonly reported use of wood (49.1-89.7%), crop residue and animal dung as cooking and heating fuel. African pregnant women reported higher use of charcoal (85.4-93.5%). Latin American pregnant women had greater use of petroleum gas. Among south Asian women, solid fuel use and cooking on an open flame inside the home were common. There was a significant association between solid fuel use and allowing smoking within the home at the Asian sites and in Zambia (p < 0.05).
Pregnant women from low/middle income countries were commonly exposed to IAP secondary to use of solid fuels. Among these populations, exposure to second-hand tobacco smoke was also common. This combination of exposures likely increases the risk of poor pregnancy outcomes among the most vulnerable women. Our study highlights the importance of further research on the combined impact of IAP and second-hand tobacco smoke exposures on adverse maternal and perinatal outcomes.
The effects of wood burning stoves on indoor air quality was investigated in a rural community of southern Brazil, during the winter season of 1991. The concentrations of polycyclic aromatic hydrocarbons (PAHs), nitrogen dioxide (NO2) and suspended particulate matter (SPM) were assessed in houses with wood stoves and the results compared with levels found in houses with gas stoves. Strikingly higher (p < 0.01) levels of PAHs, and much higher (p = 0.07) levels of SPM were found in the kitchens with wood stoves. In contrast, NO2 concentrations in the kitchen as well in personal exposure, were found to be slightly higher in houses with gas stoves. All these differences were minimally affected by smoking, outdoor air pollution or other emissions from indoor combustion products. These findings appear to support the hypothesis that domestic wood burning stoves are risk factors for some upper digestive and respiratory tract cancers in Brazil.
A case-control study of risk factors for carcinomas of the tongue, gum, floor, and other specified parts of the mouth was conducted in 3 metropolitan areas in Brazil: São Paulo (southeast), Curitiba (south), and Goiânia (central-west). We analyzed information on demographics, occupational history, environmental exposures, tobacco smoking and alcohol drinking habits, as well as diet, oral and other health characteristics obtained from interviews with 232 cases and 464 hospital non-cancer controls matched for 5-year age-group, sex, hospital catchment area and trimester of admission. Tobacco and alcohol consumption were the strongest risk factors irrespective of the anatomical site. The adjusted relative risks (RR) for ever vs. never smokers were: 6.3, 13.9, and 7.0, for industrial-brand cigarettes, pipe, and hand-rolled cigarettes, respectively. A strong correlation was seen between number of pack-years and risk. The RR for the heaviest vs. the lowest consumption categories (greater than 100 vs. less than 1 pack-years) was 14.8. Risk levels generally decreased to those of never smokers after 10 years had elapsed since stopping smoking. The risk associated with alcohol was mostly evident for wine (cancer of the tongue) and "cachaça" (all sites), a hard liquor distilled from sugar cane. Other important risk factors were drinking "chimarrão" (a type of maté), use of a wood stove for cooking, and frequent consumption of charcoal-grilled meat and manioc. Oral hygiene characteristics represented correlates of disease risk. A significant protective effect was observed for consumption of carotene-rich vegetables and citric fruits, but not for green vegetables in general.
Chronic bronchitis causes high morbidity and mortality throughout the world. It is basically a preventable disease. However, few population based studies of chronic bronchitis have been carried out in less developed countries.
A population based cross sectional survey was conducted to determine the prevalence of chronic bronchitis and associated risk factors in an urban area (Pelotas) of southern Brazil. 1053 subjects aged 40 years and over (90.3% of eligible subjects) were interviewed using the ATS-DLD-78 questionnaire.
Of the subjects interviewed 12.7% were classified as having chronic bronchitis. In univariate analyses a significant increase in the relative odds of chronic bronchitis was seen in men (OR = 2.17, 95% CI 1.50 to 3.13), low family income (OR = 2.60, 95% CI 1.47 to 4.47 for lowest quartile), low schooling (OR = 4.65, 95% CI 2.36 to 9.18 for those with no schooling), smoking habits (OR = 6.92, 95% CI 4.22 to 11.36 for smokers of 20 or more cigarettes per day), high occupational exposure to dust (OR = 2.48, 95% CI 1.56 to 3.94), inadequate housing (OR = 2.09, 95% CI 1.22 to 3.58), high level of indoor air pollution (OR = 1.86, 95% CI 1.16 to 2.99), and reported childhood respiratory illnesses (OR = 2.08, 95% CI 1.25 to 3.49). Multiple logistic regression resulted in the identification of the following independent risk factors: family income (OR = 1.99, 95% CI 1.04 to 3.81 for subjects in the lowest quartile compared with those in the highest quartile), schooling (OR = 5.60, 95% CI 2.52 to 12.45 for subjects with no schooling compared with those with nine or more years), smoking (OR = 8.10, 95% CI 4.46 to 14.71 for smokers of 20 or more cigarettes per day compared with non-smokers), and history of major respiratory illnesses in childhood (OR = 2.16, 95% CI 1.20 to 3.85).
Low family income, poor schooling, smoking, and childhood respiratory illnesses were significantly associated with chronic bronchitis.
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Gioda, A, Tonietto, G, de Leon, AP. Exposição ao uso da lenha para cocção no Brasil e sua relação com os agravos à saúde da
população.. Cien Saude Colet [periódico na internet] (2017/Dez). [Citado em 19/07/2018]. Está disponível em:
http://www.cienciaesaudecoletiva.com.br/artigos/exposicao-ao-uso-da-lenha-para-coccao-no-brasil-e-sua-relacao-com-os-agravosa-saude-da-populacao/16532?id=16532