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Effect of exposure to biomass smoke from cooking fuel types and eye disorders in women from hilly and plain regions of Nepal
  1. Matthew Patel1,
  2. Mohan Krishna Shrestha2,
  3. Anu Manandhar2,
  4. Reeta Gurung2,
  5. Steven Sadhra3,
  6. Ruth Cusack4,
  7. Nagendra Chaudhary5,
  8. Sanduk Ruit2,
  9. Jon Ayres3,
  10. Om P Kurmi4
  1. 1 Royal College of Surgeons in Ireland, Dublin, Ireland
  2. 2 Tilganga Institute of Ophthalmology, Kathmandu, Nepal
  3. 3 University of Birmingham, Birmingham, UK
  4. 4 Medicine, McMaster University, Hamilton, Canada
  5. 5 Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, Nepal
  1. Correspondence to Om P Kurmi, Department of Medicine, McMaster University, Hamilton L8S 4L8, Canada; kurmio{at}


Background/Aim To study the association between exposure to biomass smoke from cooking fuels andi cataract, visual acuity and ocular symptoms in women.

Methods We conducted a community-based cross-sectional study among women (≥20 years and without a previous diagnosis of cataract, ocular trauma or diabetes or those taking steroids) from hilly and plain regions of Nepal. Eligible participants received an interview and a comprehensive eye assessment (cataract development, visual acuity test and ocular symptoms). Participants’ data on demographics, cooking fuel type and duration of use, and cooking habits were collected. We addressed potential confounders using the propensity score and other risk factors for ocular diseases through regression analysis.

Results Of 784 participants, 30.6% used clean fuel (liquefied petroleum gas, methane, electricity) as their primary current fuel, and the remaining 69.4% used biomass fuels. Thirty-nine per cent of the total participants had cataracts—about twofold higher in those who currently used biomass fuel compared with those who used clean fuel (OR=2.27; 95% CI 1.09 to 4.77) and over threefold higher in those who always used biomass. Similarly, the nuclear cataract was twofold higher in the current biomass user group compared with the clean fuel user group (OR=2.53; 95% CI 1.18–5.42) and over threefold higher among those who always used biomass. A higher proportion of women using biomass had impaired vision, reported more ocular symptoms compared with those using clean fuel. Severe impaired vision and blindness were only present in biomass fuel users. However, the differences were only statistically significant for symptoms such as redness, burning sensation, a complaint of pain in the eye and tear in the eyes.

Conclusions Cataract was more prevalent in women using biomass for cooking compared with those using clean fuel.

  • Epidemiology
  • Eye (Globe)
  • Vision

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  • MP, MKS, AM, JA and OPK contributed equally.

  • Twitter Nagendra Chaudhary @nagendraaiims.

  • Acknowledgements We would like to thank all the research assistants from the Tilganga Institute of Ophthalmology who helped in the data collection and all the participants for taking part in this study. The authors attest that they meet the current ICMJE criteria for authorship.

  • Contributors OPK and JA conceived the study, participated in its design, data acquisition and/or research execution, data analysis and/or interpretation, and manuscript preparation and/or revision. MKS and AM were involved in data acquisition and/or research execution, data interpretation and manuscript revision. MP was involved in data analysis and/or interpretation and wrote the first draft of the manuscript. SS, NC and RC were involved in the data interpretation and manuscript revision.

  • Funding This was supported by the University of Birmingham, UK, as internal seed funding (no reference number). The funder had no role in data collection, analysis and interpretation of the results.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The research followed the tenets of the Declaration of Helsinki and was approved by the institutional ethical committee of the Tilganga Institute of Ophthalmology (reference number: 1/2011–2012). Informed consent was obtained from the subjects and their guardians after an explanation of the nature and possible consequences of the study. For those who were unable to read or write, the purpose of the study and consent form was read out, and if they agreed to participate, thumb impressions were taken instead of their signatures.

  • Provenance and peer review Not commissioned, externally peer-reviewed.

  • Data availability statement Data are available upon reasonable request. The data used to support the findings of this study are available from the corresponding author upon request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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