Exposure reductions associated with introduction of solar lamps to kerosene lamp-using households in Busia County, Kenya

Solar lamps are a clean and potentially cost-effective alternative to polluting kerosene lamps used by millions of families in developing countries. By how much solar lamps actually reduce exposure to pollutants, however, has not been examined. Twenty households using mainly kerosene for lighting were enrolled through a secondary school in Busia County, Kenya. Personal PM_2.5 and CO concentrations were measured on a school pupil and an adult in each household, before and after provision of 3 solar lamps. PM_2.5 concentrations were measured in main living areas, pupils' bedrooms, and kitchens. Usage sensors measured use of kerosene and solar lighting devices. Ninety percent of baseline kerosene lamp use was displaced at 1-month follow-up, corresponding to average PM_2.5 reductions of 61% and 79% in main living areas and pupils' bedrooms, respectively. Average 48-h exposure to PM_2.5 fell from 210 to 104 μg/m³ (-50%) among adults, and from 132 to 35 μg/m³ (-73%) among pupils. Solar lamps displaced most kerosene lamp use in at least the short term. If sustained, this could mitigate health impacts of household air pollution in some contexts. Achieving safe levels of exposure for all family members would likely require also addressing use of solid-fuel stoves.

HIV sero-prevalence among tuberculosis patients in Kenya

OBJECTIVE

To determine HIV seroprevalence among tuberculosis patients and the burden of HIV attributable tuberculosis among notified patients in Kenya.

DESIGN

A cross-sectional anonymous unlinked HIV seroprevalence survey.

SETTING

Tuberculosis diagnostic clinics of the National Leprosy Tuberculosis Programme in 19 districts.

SUBJECTS

One thousand nine hundred and fifty-two newly notified tuberculosis patients.

INTERVENTIONS

Selection and registration of eligible subjects followed by obtaining 5 ml of full blood for haemoglobin testing and separation of serum for HIV testing by ELISA.

MAIN OUTCOME MEASURES

HIV seroprevalence per district and burden of HIV attributable tuberculosis among tuberculosis patients.

RESULTS

A total of 1,952 eligible patients were enrolled. The weighted seroprevalence in the sample was 40.7% (range 11.8-79.6% per district). The seroprevalence was significantly higher among females and patients with sputum-smear negative tuberculosis. Chronic diarrhoea, female sex, oral thrush and a negative sputum were independent risk factors for HIV infection. The Odds ratio for HIV infection in female tuberculosis patients aged 15-44 years, was 5.6 (95% CI 4.5-6.9) compared with ante-natal clinic attenders. The population attributable risk was 0.22 in 1994.

CONCLUSION

The HIV epidemic has had a profound impact on the tuberculosis epidemic in Kenya and explains about 41% of the 94.5% increase of registered patients in the period 1990-1994 and 20% of all registered patients in 1994. Repetition of the survey with inclusion of a more representative control group from the general population may provide a more accurate estimation of the burden of HIV attributable tuberculosis.