ISEE-756 Objective: Indoor air pollution from use of solid biomass fuels is a risk factor for childhood acute lower respiratory infections (ALRI) in developing countries, but little is known about the exposure-response relationship. No prior epidemiological studies have directly measured personal exposure to a component of biomass smoke among young children. We therefore analyzed data from a randomized stove intervention conducted in Guatemala during 2002–2004 to evaluate the association between incidence and severity of ALRI and personal exposure to carbon monoxide (CO) among 500 children. Materials and Methods: Personal 48-hour average exposure to CO, a major component of biomass smoke, was measured on an average of 4 times during the first 18 months of life to estimate each child's mean exposure during follow-up. ALRI was ascertained by weekly household surveillance by trained fieldworkers combined with assessment by physicians blinded to intervention status. Exposure-response relationships were estimated using generalized estimating equations to perform pooled logistic regression, adjusting for demographic, socioeconomic, and housing characteristics, and other sources of indoor air pollution. Results: A lower than 1 ppm exposure to CO, equivalent to the 50% reduction in the geometric mean child exposure associated with the stove intervention, was associated with a 22% lower (95% CI: −38%, −2%) risk of ALRI. The association was substantially stronger for more severe ALRI with hypoxemia (29% reduction; 95% CI: −47%, −6%). Conclusions: Our findings indicate that early childhood exposure to indoor biomass smoke, a common exposure in developing countries, is associated with substantially greater risk of ALRI, the leading cause of childhood mortality globally.
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McCracken et al. (2007) studied this question.