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Training Years: 2013-2014

Training Site: UNC Project-Malawi

Country: Malawi

Mentor: Irving Hoffman, PA, MPH

Title: Tuberculosis/HIV co-infection and household air pollution (HAP) from woody biomass use in Malawi: A Case-Control Study

Project Objectives:

Hypothesis and specific aims: Malawi is a critical case for examining the connection between TB and HAP. Tuberculosis is a persistent health problem in Malawi (WHO 2011), and there is almost universal dependence on biomass for cooking. Further, in urban settings, kerosene, also a hypothesized risk factor for TB (Pokrel et al. (2012), is used for lighting and heating (GOM 2009). While HAP is a hypothesized risk factor for TB in Malawi, only one study has examined the connection between the two. A case control study in Karonga District found no evidence of an association between HAP and TB (Crampin et al. 2004). However, this study took place in a rural setting where there was little or no variation in fuel type, cooking technology and setting, the three variables that mediate exposure to household air pollution. These results are in contrast to several other studies, which have identified a positive association between HAP and TB (i.e. pooled OR 1.30: 95% CI, 1.04 -1.62; P=0.02) (Sumpter and Chandramohan 2012). This study has three specific aims.

Aim 1: Investigate the association between fuel use and TB. Explore the relative role fuel wood, charcoal and kerosene used for cooking, heating and lighting as risk factors for TB.

Aim 2: Estimate dose-response relationships between carbon monoxide (CO) and particulate matter (PM) exposure and incidence of TB using direct measurements of exposure for individuals and households No study of the relationship between HAP and TB has included direct measurement of exposure.

Aim 3: Explore the role of spatial and environmental factors related to fuel and cooking choices as determinants of TB Household and neighborhood characteristics are hypothesized to influence the role of HAP as a risk factor for contracting TB

NIH Support: Fogarty fellowship postdoctoral training award

Career Development Award: K01-HD073329 (2012-2017) Population, land use and health dynamics of biomass fuel use in sub-Saharan Africa

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