The effect of biomass smoke exposure on quality-of-life among Ugandan patients treated for tuberculosis: A cross-sectional analysis

Sophie Wennemann; Bbuye Mudarshiru; Stella Zawedde-Muyanja; Trishul Siddharthan; Peter D Jackson

doi:10.1371/journal.pgph.0002892

The effect of biomass smoke exposure on quality-of-life among Ugandan patients treated for tuberculosis: A cross-sectional analysis

PLOS Glob Public Health. 2024 Feb 8;4(2):e0002892. doi: 10.1371/journal.pgph.0002892. eCollection 2024.

Authors

Sophie Wennemann¹, Bbuye Mudarshiru², Stella Zawedde-Muyanja³, Trishul Siddharthan⁴, Peter D Jackson⁵

Affiliations

¹ Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America.
² Makerere University Lung Institute, Kampala, Uganda.
³ Infectious Disease Institute, Makerere University College of Health Science, Kampala, Uganda.
⁴ Division of Pulmonary and Critical Care, University of Miami, Miami, Florida, United States of America.
⁵ Division of Pulmonary Critical Care, Virginia Commonwealth University, Richmond, Virginia, United States of America.

Abstract

More than half the global population burns biomass fuels for cooking and home heating, especially in low-middle income countries. This practice is a prominent source of indoor air pollution and has been linked to the development of a variety of cardiopulmonary diseases, including Tuberculosis (TB). The purpose of this cross-sectional study was to investigate the association between current biomass smoke exposure and self-reported quality of life scores in a cohort of previous TB patients in Uganda. We reviewed medical records from six TB clinics from 9/2019-9/2020 and conducted phone interviews to obtain information about biomass smoke exposure. A random sample of these patients were asked to complete three validated quality-of-life surveys including the St. Georges Respiratory Questionnaire (SGRQ), the EuroQol 5 Dimension 3 Level system (EQ-5D-3L) which includes the EuroQol Visual Analog Scale (EQ-VAS), and the Patient Health Questionnaire 9 (PHQ-9). The cohort was divided up into 3 levels based on years of smoke exposure-no-reported smoke exposure (0 years), light exposure (1-19 years), and heavy exposure (20+ years), and independent-samples-Kruskal-Wallis testing was performed with post-hoc pairwise comparison and the Bonferroni correction. The results of this testing indicated significant increases in survey scores for patients with current biomass exposure and a heavy smoke exposure history (20+ years) compared to no reported smoke exposure in the SGRQ activity scores (adj. p = 0.018) and EQ-5D-3L usual activity scores (adj. p = 0.002), indicating worse activity related symptoms. There was a decrease in EQ-VAS scores for heavy (adj. p = 0.007) and light (adj. p = 0.017) exposure groups compared to no reported exposure, indicating lower perceptions of overall health. These results may suggest worse outcomes or baseline health for TB patients exposed to biomass smoke at the time of treatment and recovery, however further research is needed to characterize the effect of indoor air pollution on TB treatment outcomes.

Copyright: © 2024 Wennemann et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

Funder Name: NIH, CTSA award No. UL1TR002649 from the National Center for Advancing Translational Sciences to support data collection (P.J.) Funder Name: CHEST Foundation Grant Number: Chest Foundation/ATS Research Grant in COVID and Diversity Grant Recipient: Dr Peter Durham Jackson Funder Name: American Thoracic Society Grant Number: Chest Foundation/ATS Research Grant in COVID and Diversity Grant Recipient: Dr Peter Durham Jackson Funder Name: School of Medicine, Virginia Commonwealth University Grant Number: DOIM Pilot Grant Grant Recipient: Dr Peter Durham Jackson The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.