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income and disease classification
- Wenbin Liang (19 October 2005)
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Chimney Sweeps
- Soaring Bear (7 November 2005)
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Qualitative research exploring stove users' perceptions
- Joanna K Gordon (24 November 2005)
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Wenbin Liang, taking master of public health Curtin University of Technology
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Dear Editor, I agree with the paper that reducing the use of unvented stoves in the population plays an important role in reducing the incidence of COPD.[1] However socio-economic status/income level may positively associated with the chance of installing a chimney, while socio-economic status/income level is likely to be associated with misclassification of the disease. COPD patients with low income and could not afford to build a chimney may be less likely to see a doctor and less likely to get diagnosed. Nevertheless people without a chimney and go to see a doctor regarding aspiratory symptoms are more likely to be diagnosed as COPD. In China, the accuracy of diagnosis as well as the medical cost, varies greatly among different level of hospitals due to the quality of doctors and availability of equipments. Therefore the disease misclassification in this situation would be very complex , and the level of disease misclassification must be justified to get a better estimation. As COPD is unlikely to be cured, a random sample could be drawn and further examined by standard diagnosis criteria to understand the degree of misclassification and adjust for it in the analysis. However the interview was done in 1992, and it would be too late now. Reference 1. Chapman, R. He, X. Blair, A. Lan, Q. Improvement in household stoves and risk of chronic obstructive pulmonary disease in Xuanwei, China: retrospective cohort study. BMJ, doi:10.1136/bmj.38628.676088.55 (published 18 October 2005) . Competing interests: None declared |
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Soaring Bear, informationist Bethesda Md 20895
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Reduction in COPD is surely going to be offset by increases of cancer and other inflammations in those who will clean all of those chimneys as they become encrusted with soot. Competing interests: None declared |
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Joanna K Gordon, PRHO St. James' University Hospital, Leeds. LS9 7TF
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Editor, Chapman et al.'s paper (1) supports further the evidence showing that household stoves burning coal and biomass, increase the risk of respiratory illness in the developing world. However, there is still a lack of qualitative research in this field investigating stove users' views. Without such studies, it is difficult to know how stove users' practice can be changed. In Ulaanbaatar, Mongolia the World Bank are implementing an improved stove programme, selling stoves which allow more complete combustion of coal and biomass and therefore produce less pollutants. In other countries, this has been shown to reduce the incidence of lower respiratory infections (2). In 2003 I conducted a qualitative study on stove users' perceptions of the health effects of stoves in Mongolia (3). Interestingly, those using the stoves recognised many health effects and they felt that the stoves played a key role in their wellbeing. However, the World Bank had neglected health issues in their marketing, focussing only on the opportunity for buyers to save money on the reduced amount of fuel needed for the new stoves. It seems that health is of great importance to those using stoves and potential health benefits could be used to promote less polluting stoves. If more qualitative research was carried out exploring stove users' views, a more tailored, effective marketing strategy could be adopted to persuade families to invest in improved stoves and thus reduce the burden of respiratory disease. 1) Chapman R, He X, Blair A, Lan Q. Improvement in household stoves and risk of chronic obstructive pulmonary disease in Xuanwei, China: retrospective cohort study. BMJ 2005;331;1050-5. 2)Ezzati M & Kammen D. Evaluating the health benefits of transitions in household energy technologies in Kenya. Energy Policy 2002;30;815-826. 3)Gordon J, Emmel N, Manaseki S, Chambers J. Perceptions of the Health Effects of Stoves. Pending publication in Journal of Health, Organisation and Management. Competing interests: None declared |
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