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Huang and colleagues focused on outdoor air pollution. (1) To complement their efforts, indoor air pollution may be considered as a potential topic for future researches. As air pollution has been gaining recognition as a contributory factor for stroke, particularly in low and middle income countries, the use of biomass fuel is being targeted for replacement as a risk-reduction strategy.
India is no exception, implementing the Ujjwala scheme to provide clean fuel to the poor population and reaching out to more than 80 million families. (2) A few states like Delhi, Goa and Tamil Nadu are performing better than the rest of the country in this regard. It is interesting to note that the stroke specific mortality rates of these states are less than the country average. On the other hand, states like Odisha with low acceptance of clean fuel are witnessing high stroke mortality. (3,4) There is ample scope for longitudinal studies for measuring the effect of such exposure.
Being a Non-Communicable Disease with multi-factorial causation, stroke has established itself as a challenge for the upcoming decade. Reducing the use of biomass fuel may act as a critical public health approach in countries with limited resources in reducing the occurrence of stroke and subsequent deaths.
1. Huang K, Liang F, Yang X, et al. Long term exposure to ambient fine particulate matter and incidence of stroke: prospective cohort study from the China-PAR project. BMJ 2019;367:I6720.
2. Govt. of India. Pradhan Mantri Ujjwala Yojana. (Available at https://pmuy.gov.in/, last accessed on 9th January, 2020)
3. International Institute for Population Sciences (IIPS), ICF. National Family Health Survey (NFHS-4), 2015-16: India. Mumbai: IIPS. 2017.
4. Indian Council of Medical Research, Public Health Foundation of India, Institute for Health Metrics and Evaluation. India: Health of the Nation's States - The India State-level Disease Burden Initiative. New Delhi, India: ICMR, PHFI, and IHME. 2017.